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S.   S.  <&   W.   Wood's  Medical   Catalogue. 

Clinical  Lectures  on  the  Principles  and  Practice 
of  Medicine. 

BY  JOHN  HUGHES  BENNETT,  M.D.,  F.R.8.E., 

Professor  of  Institutes  of  Medicine,  and  Senior  Professor  of  Clinical  Medicine  in  the 
University  of  Edinburgh, 

1  vol.  8vo.  1005  pages.    "With  five  hundred  Illustrations  on  Wood. 

Price,  If 6,  free  of  Postage. 

""We  recommend  this  volume  with  the  most  unqualified  praise,  to  the  attentive  considera- 
tion of  the  practitioner  and  students.     "We  have  met  with  DO  work  of  late  years  00  I). 
eiples  of  Alodlcine  more  likely  to  advance  the  truo  and  rightful  study  of  our  art." — Med    •> 
'limes  and  Gazette. 

"One  of  the  most  valuablo  books  which  havfi  lately  emanated  from  the  medical  press.  No 
one  devoted  to  the  profession  will  fail  to  peruse  theso  lectures,  and  acquaint  himself  with  the 
discoveries  of  so  ardent  an  explorer  in  the  field  of  medicine." — New  Yurie  Journal  of  Medi- 
eine. 

""We  most  heartily  commend  it  to  the  young  and  old,  tho  disciple  and  the  master  alike." — 
Charleston  Me*~ical  Journal  and  Review. 

"  A  new  work,  in  which  tho  applications  of  the  microscope  to  clinical  medicine  are  treated 
by  a  mastor  hand.  Tho  great  value  of  this  work  is,  that  it  embodies,  in  a  clear  and  concise 
manner,  all  the  applications  of  the  microscope  to  practical  medicine.  It  is,  in  fact,  a  perfect 
manual  on  this  Bubject,  and  as  much  to  be  welcomed  by  all  who  consider  di°,gnosis  as  the 
most  important  element  in  the  study  of  disease." — New  Orleans,  Medical  News  and  Ifospi 
tal  Gazette. 

SILVER   SUTURES  EST  SURGERY. 

BY  J.  MARION  SIMS,  M.D., 

Surgeon  to  the  Women's  Hospital. 

69  pages,  8vo.,  with  Illustrations  on  "Wood 

Price,  50  cents,  free  of  Postage. 

OF  NATURE  AND  ART  IN  THE  CURE  OF  DISEASE. 

BY  SIR  JOHN  FORBES,  M.D.  (OXON.),  F.B.S., 

Fellow  of  the  Royal  College  of  Physicians,  Physician  to  the  Queen's  Household,  etc.,  etc 

From  the  Second  London  Edition. 

Price,  $1,  free  of  Postage. 

"  The  error  which  the  author  regards  as  the  great  taint  of  medical  science,  and  which  he 
combats  throughout  the  book,  is  a  want  of  trust  in  the  powers  of  Nature  to  arrest  the  pro- 
cesses of  disease,  and  a  consequent  overweening  faith  in  remedial  agents  as  the  sole  means  of 
cure.  His  m»in  object  is  to  endeavor  to  expose  these  misconceptions,  and  to  impress  the 
minds  of  the  younger  and  less  prejudiced  members  of  the  profession  with  the  truth  and 
importance  of  the  principles  advocated,  and  also  to  prepare  a  work  which  might  convey  to 
educated  members  of  the  general  public  a  juster  knowledge  of  the  real  nature  of  disease,  and 

the  true  character  and  powers  of  the  medical  art "We  cannot  but  believe 

that  the  courageous  advocacy  by  Sir  John  Forbes  of  views  so  much  opposed  to  the  prejudices 
of  a  large  class  in  the  profession,  have  contributed  not  a  little  towards  the  reformation  of  the 
drugging  system.  Most  sincerely  do  we  thank  him  as  a  benefactor  of  his  profession  and  of 
mankind." — Brit,  and  For.  Medico- Chirurgical  Review. 

"  This  boot  gives  explicit  and  coherent  expression  to  that  feeling  of  reaction  against  violent 
or  perturbative  practice,  which  has  been  going  on  in  the  profession  for  the  last  twenty-five 
years,  and  may  now  be  considered  as  settled  and  fixed  He  explodes,  almost  by  a  simple 
statement  of  it,  the  opinion  of  disease  being  a  separate  entity  destructible  by  the  introduction 
into  the  system  of  an  appropriate  remedy ;  and  he  recalls  to  our  attention,  in  a  truly  philo- 
sophical form,  the  sanative  powers  of  Nature All  this,  Sir  John  Forbes  does  ably 

-\4  well,  and  we  listen  to  him  with  the  attention  due  to  a  master  in  Israel." — Edinburgh 
msdical  Journal. 

"  In  this  volume  Sir  John  Forbes  aims  to  show  that  Nature  has  much  more  to  do  with  tne 
cure  of  disease  than  is  generally  supposed  either  by  laymen  or  by  the  profession,  and  that  Art 
»**complishes  much  less  in  that  way  than  is  commonly  imagined.  The  book  is  designed  not 
e^erely  for  the  profession,  but  for  intelligent  readers  generally." — British  Quarterly  Review. 

.  .  .  .  "  We  recommend  this  thoughtful  and  suggestive  book  to  the  careful  perusal  of 
»il  who  value  health,  and  especially  to  those  who  habitually  resort  to  medicine.  They  will  be 
kegs  ready  to  fly  to  pills  ind  powders  when  they  know  th»  mischief  these  produce." — The 
Critic. 


&.    <S.   4*    W.    Wood's  Medical   Catalogue. 


A  MANUAL  OF  OBSTETEICS. 

BY  THOMAS  F.  COCK,  M.D., 

Physician  to  the  New  York  Lying-in  Asylum. 

Price  $1,  free  of  postage. 

"  We  doubt  if  more  matter  could  well  be  compressed  into  the  same  space  than  has  been  done 
lli  this  unpretending  little  book,  which  is  the  very  type  of  a  'manual.'  It  is  indeed,  as  on* 
author  calls  it,  a  skeleton  collection  of  facts ;  and  they  are  such  facts  as  every  one  ought  to  be 
acquainted  with." — New  York  Med.  Times. 

"An  excellent  companion  for  the  lecture-room." — Peninsular  Journal  of  Med. 

"Incomparably  the  best  mulium  inparvo  we  have  seen." — Med.  Chron. 

"  A  most  excellent  compendium  of  midwifery.  It  should,  indeed,  be  the  Obstetrician's  Vade 
Mecum." — Nelson's  American  Lancet. 

"  A  plain,  sensible,  judicious,  and  reliable  manual." — Kentucky  Med.  Recorder. 

"An  able  and  valuable  work,  abounding  in  useful  Information,  from  which  all  may  reap  bene- 
fit."— Med.  Examiner. 

"  Well  adapted  to  the  student  attending  lectures,  as  it  presents  to  him  at  a  view,  briefly  and 
yet  as  thoroughly  as  can  well  be,  the  facts  which  may  be  presented  to  his  notice  in  the  lecture- 
room.  It  must  undoubtedly  meet  with  favor,  not  only  with  the  student,  but  likewise  with  the 
advanced  practitioner,  who  can,  without  wading  through  a  mass  of  speculative  views,  at 
once  refer  to  any  facts  he  may  require  to  refresh  his  mind  with,  in  moments  of  emergency 
and  forgetfulness." — Eclectic  Medical  Journal. 

"It is  a  valuable  book  for  students— is  cheap— and  we  advise  our  young  friends  to  possess 
themselves  of  It." — Nashville  Jaurnal  of  Medicine  and  Surgery. 


OR,    MANUAL    OF    ANATOMY- 

Comprising  a  description  of  the  Bones,  Muscles,  Vessels,  Nerves,  and  Viscera;  also  the 
relative  Anatomy  of  the  different  regions  of  the  human  body, 
with  the  Elements  of  Pathology. 
BY  ROBERT  ITARRISON,  A.M.,  M.B., 
Professor  of  Anatomv  in  the  Royal  College  of  Surgeons,  in  Ireland,  Ac 
Third  Edition.    With  additions  by 
ROBERT  WATTS,  JR.,  M.D., 
Professor  of  Anatomy  in  College  of  Physicians  and  Surgeons,  N.  Y. 
Price  $1  25,  free  of  postage. 
"A  work  of  such  sterling  merit  may  well  be  the  companion  of  every  student  in  the  dissect- 
ing-room."— Peninsular  Jour,  of  Med. 

"  Its  descriptions  are  clear  and  accurate,  and  Its  instructions  to  the  dissector  are  such  as  te 
make  the  most  advantageous  use  of  material."— Buffalo  Med.  Jour. 

"Our  experience  enables  us  to  recommend  it  cordially  to  every  student  of  anatomy ." — 
Stethoscope. 

"  We  consider  its  method  of  arrangement  to  be  one  of  the  very  best  for  communicating  prac- 
tical anatomical  knowledge,  with  a  view  at  once  to  clearness,  completeness,  and  economy  of 
material." — Memphis  Medical  Recorder. 

MATERIA  MEDICA  AND  THERAPEUTICS. 

BY  MAETYN  PAINE,  A.M.,  M.D.,  LL.D, 

Professor  of  the  Institutes  of  Medicine  and  Materia  Mjdica  in  the  University  of  New  York, 

<&c,  die. 

Price,  $1  25 

"It  abounds  in  facts,  presented  in  the  fewest  words ;"  it  "  gives  the  essence  of  all  the  great 
treatises  extant,  on  the  Materia  Medica,  and  therefore  must  always  be  a  convenient  book  for 
reference  as  authority." — Boston  Medical  and  Surgical  Journal. 

"  We  have  no  doubt  the  objects  of  the  profound  author  are  fully  carried  out  in  the  work,  and 
It  must  prove  of  great  assistance  to  a  student  attending  his  lectures." — Southern  Medical  and 
Surgical  Journal. 

"As  a  text-book  for  the  student,  and  as  a  convenient  reference-book  for  the  practitioner,  we 
Begard  it  as  a  very  valuable  contribution  to  the  profession." — Missouri  Med.  &  Surg.  Journal. 

"  To  the  young  gentlemen  attending  his  lectures  it  will  prove  a  convenient  and  useful  work." 
—  Western  Jourhul  of  Medicine  and  Surgery. 

"  It  will  be  found  to  be  a  useful  and  convenient  book  for  determining  readily  the  properties 
and  doses  of  different  medicines,  and  for  ascertaining  what  are  the  proper  doses  and  most  ap- 
proved formula  to  be  used  in  their  administration,  and  as  such  we  cheerfully  recommend  it" — 
North-  Western  Medical  and  Surgical  Journal, 


S.   S.  8f   W.    Wood's  Medical  Catalogue. 


Microscopic  Anatomy  of  tho  Human  Body, 

IN  HEALTH  AND  DISEASE. 

Illustrated  with  nil  morons  drawings  In  color,  by  Arthur  HiLL  ELUSALL,  M.B. ;  Member  of  Koy  M 
College  of  Burgeons  of  England,  &c,  &c.    With  addition!  to  tho  Text  and 
Plato*,  mid  an  Introduction,  containing  Instructions  in 
Microscopic  Manipulation, 
BY  HENRY  VAN  AR3DALE,  BtD. 
Price  $7,  free  of  postage. 
2  vols.  8vo.,  79  plates. 
"  Kvery  page  of  It  Is  a  banquet,  unfolding  tho  marvels  of  creative  wisdom  and  powor.    Such 
extraordinary  displays  of  the  minute  organization  of  the  internal  mechanism  of  our  bod1<  t   m 
the  two  conditions. of  health  and  disease,  create  a  strange  fooling  of  wonder  and  amazement 
While  tho  work  teaches  how  to  understand  appearances,  It  also  points  out  the  physio 
functions  and  anatomical  relations  of  parts.    In  short,  the  why  and  the  wherefore  in  the  birb- 
Jucts  treated  of  aro  presented  in  a  clear  light.1' — Boston  Medical  anil  Surgical  Jtrumul. 

"  We  express  the  conviction,  forced  upon  us,  after  several  years'  consultation  of  Rlmilat 
works,  while  pursuing  microscopical  studies,  that,  there  is  none  better  arranged  and  llln  '  fited, 
and  none  which  will  give  so  general  satisfaction,  as  that  of  Mr.  Ilassall,  edited  by  Dr.  Van 
Arsdale." — New  York  Journal  of  Medicine. 

"  It  is  marked  by  a  simplicity  of  description,  and  by  scientific  accuracy  In  argument.  With 
these  (the  plates)  we  are  delighted.  The  coloring  is  magnificent — not  too  high,  nothing  extra- 
vagant about  It,  but  truthful,  neat,  accurate,  and  faithfully  representing  the  objects  as  we  have 
sometimes  seen  them  In  the  choicest  specimens  of  Parisian  mounting." — Buffalo  Med.  Jour. 

"  It  is  pre-eminently  the  best  Illustrated  microscopic  human  anatomy  that  is  accessible  to  na 
in  this  country." — Medical  Exa/miner. 
"  A  work  of  acknowledged  ability  and  interest." —  Western  Journal  of  Medicine  and  Surgery. 
"  It  is  not  merely  a  scientific,  but  it  is  furthermore  a  practical  treatise;  and  in  both  characters 
It  equally  sustains  a  high  character.    The  getting  up  of  the  illustrations  is  exquisite ;  each  one 
■arms  a  perfect  picture." — Medical  Chronicle. 
"The  most  complete  In  this  department ." — Nelson's  American  Lancet. 
"It  Is  magnificently  published.     It  is  the  only  complete  work  of  the  kind  In  the  English  lan- 
guage, and  reflects  high  credit  upon  its  learned  and  Indefatigable  author." — Southern  MeilicaX 
and  Surgical  Journal. 

PRINCIPLES  OF  PHYSIOLOGY, 

Designed  for  the  use  of  Schools,  Academies,  Colleges,  and  the  General  Reader. 

Comprising  a  familiar  explanation  of  the  Struotttbr  and  Functions  op  thb  Organs  of  Mar 

illustrated  by  comparative  reference  to  those  of  the  Inferior  Animals. 

ALSO,  AN  ESSAY  ON  THE  PRESERVATION  OF  HEALTH. 

With  14  quarto  plates,  and  over  80  engravings  on  wood,  making  in  all  nearly  200  figures. 

Price  $8  colored,  or  $2  25uncolored,  free  of  postage. 

BY  J.  COMSTOCK  AND  B.  M.  COMINGS,  M.D. 

"  Nothing  can  be  more  appropriate.    It  is  a  fascinating  book  for  man,  woman,  or  child.    Wa 

hope  the  trustees  of  institutions  will  give  an  early  attention  to  this  valuable  and  unexceptionable 

treatise  on  human  organization."— Boston  Med.  and  Surg.  Jour. 

'Adndrably  adapted  to  the  purpose  designed." — J.  H.  Aemsbt,  M.D.,  Prof  of  An  at.  in 
Albany  Med.  Col. 

""We  bail  with  satisfaction  that  advance  in  the  education  of  the  young  which  calls  from  the 
press  such  publications." — Neto  Jersey  Med.  Reporter. 

"  It  Is  the  best  popular  work  on  the  subject  which  we  have  ever  seen." — Peninsular  Jour, 
of  Med. 

"  Well  adapted  to  the  use  of  the  general  student.    It  ■will  be  found  to  present  clear  outlines  of 
s  subject  that  should  be  an  essential  branch  of  every  one's  education." — Med.  Examiner. 
"  It  is  the  ultimatum  in  descriptive  physiology." — Lockport  Courier. 

One  of  the  CHEAPEST  PERIODICALS  published  : 

The  British  and  Foreign  Medico-Chirnrgical  Eeview, 

Or  Quarterly  Journal  of  Practical  Medicine  and  Surgery. 
Price,  THREE  DOLLARS  a  year,  FREE  OF  POSTAGE  to  all  who  pay  in  advance. 
"Has  done  more  to  elevate  the  standard  of  English  Medical  Literati  ire,  than  any  other  simile 
publication." — Medical  Chronicle. 

"  Without  Its  perusal  no  physician  can  be  considered  posted  np  in  the  medical  literature  oas 
Improvements  of  the  day." — Baltimore  Patriot. 

"  yi  e  cannot  but  be  struck  with  the  amount,  variety,  end  extent  of  Information  this  Journal 
offers  to  the  practitioner." — Northern  Lancet. 


S.    S.   Sf    W.    Wood's   Medical   Catalogue. 

A   Treatise    on    Venereal    Diseases, 

BY  A.  VIDAL  (DE  CASSIS), 

Burgeon  of  the  Venereal  Hospital  of  Paris ;  Author  of  the  Traite  ile  Patholagle  Extern©  ot  de 

Medecine  Operatoire,  &c.  &c. 

>V  ITU    ('OKI  H  li  !)    P  L  A  T  E  S  . 

Translated  and  Edited  by  GEORGE  C.  BLACKMAN,  M.D., 

"Fellow  of  the  Royal  Medical  and  Chirurgical  Society  of  London,  &o.,  &e. 

Third  edition. 

Price  $3  50,  free  of  postage. 

"  One  of  the  most  valuable  works  that  has  recently  been  issued  from  the  press."—  Medical 
&eaminer.fy 

■' We  regard  the  present  work  as  the  best  general  treatise  that  has  ever  been  r-ablished  on 
Syphilis,  and  are  much  mistaken  if  it  does  not  soon  become  the  authority  of  the  day.  Tho 
colored  illustrations  are  the  most  beautiful  and  faithful  things  of  the  kind  we  havo  yet  seen." — 
Medical  Chronicle. 

"The  best  general  treatise  on  Syphilis  extant." — Langbton  Paeker,  Surgeon  to  the  Queen's 
Hospital,  Birmingham. 

"  To  every  country  practitioner  we  say,  obtain  the  work  of  vidaL  The  precepts  are  excellent, 
the  plates  magnificent." — Georgia  Blister  and  Critic. 

"  We  do  not  know  a  better." — New  Jersey  Medical  Reporter. 

"  We  have  never  seen  a  book  on  this  subject  which  appeared  so  well  calculated  to  meet  the 
wants  of  students  and  young  practitioners  as  this." — Ne>w  Hampshire  Journal  of  Medicine. 

"  A  better  work  than  this  of  M.  Vidal's  is  not  extant" —  Western  Lancet. 

"Of  inestimable  value  to  the  practitioner,,  both  for  its  principles  and  practice." — New  Orleans 
Medical  and  Surgical.  Journal. 

"A  library  in  itself,  full  of  valuable  hints  and  landmarks,  whereby  tho  physician  may  assist 
his  own  experience  and  reason  to  unravel  the  knotty  points,  and  decide  on  the  more  difficult 
ijuestions  arising  in  venereal  surgery." — Peninsular  Journal  of  Medicine. 

"We  most  cordially  recommend  it  to  the  consideration  of  our  readers." — Upper  Canada 
Journal. 

"  One  of  the  most  complete  and  usefnl  treatises  on  syphilitic  diseases  we  know." — Southern 
Medical  and  Surgical  Journal. 

Essays   en    Infant    Therapeutics; 

To  which  are  added,  Observations  on  Ergot ;   History  of  the  Origin  of  the  Use  of  Mercury  1b 

Inflammatory  Complaints;  with  the  Statistics  of  the  Deaths  from  Poisoning 

in  New  York,  in  the  Years  1841-'2-,3, 

BY  JOHN  B.  BECK,  M.D., 

Professor  of  Materia  Medlca  and  Medical  Jurisprudence  in  the  College  of  Physicians  andSurgeoBt 

of  New  York,  &c,  &c. 

Second  Edition.    Enlarged  and  Revised. 

Price  75  cts.,  free  of  postage. 

"  A  perfect  gem.    We  regard  It  as  one  of  the  most  useful  books  In  our  library." — New  Jersey 

Med.  Reporter. 

"  A  most  valuable  and  admirable  work  It  is — one  which  the  interests  of  humanity  will 
scarcely  allow  any  physician  to  be  without." — Peninsular  Jour,  of  Med. 

"  One  of  the  most  valuable  books  which  ever  issued  from  any  press.  No  one,  however 
learned,  can  read  it  without  profit." — N.  Hampshir.  Jour,  of  Med. 

"  It  is  certainly  a  very  valuable  work,  and  should  go  as  the  companion  and  antidote  of  most 
of  cur  works  on  the  diseases  of  infants,  to  modifv  !ieir  reckless  recommendation  of  the  use  ol 
the  most  powerful  drugs  on  the  susceptible  conspirations  of  children." — Bvj/alo  Med.  Jour. 
"An  excellent  little  work,  from  the  very  highest  authority." — Western  Lancet. 
"This  little  book  should  be  In  the  hands  of  every  physician  Its  moderate  cost,  and  rare 
conciseness  and  practicalness,  entitle  it  to  attention  aud  confidence;  while  the  high  standing 
of  its  lamented  author,  and  his  large  experience,  afford  a  safe  guaranty  against  error."-  Mem- 
phis Medical  Recorder. 

THE  MEDICAL  PROFESSION  IN  AHCIENT  TIMES. 

By  JOHN  WATSON,  M-D.,  Surgeon  to  the  New  York  Hospital 
Price  $1  50 — or  $1  75  by  mail,  free  of  postage. 
"The  result  of  long  ind  laborious  Investigation  on  the  part  of  the  author,  to  whom  th« 
thanks  of  the  profession  are  due,  for  a  most  interesting  and  agreeable  sketch  of  the  history  of 
ancient  medicine.*' — Boston  Medical  and  Surgical  Journal. 

"  One  of  the  most  valuable  histories  of  ancient  medicine  which  has  yet  been  published."— 
North-  Western  Medical  and  Surgical  Journal. 


8.   S.  $f    W.    Wood's  Medical  Catalogue. 
LECTURES  OH  THE  ERUPTIVE   FEVERS, 

A.S  NOW  IN  THK  OOUESB  OP   DELIVERY   AT  ST.   THOMAS*   HOSPITAL,    LONDON. 

By  OEORGE  GREGORY,  M.  D., 

Fellow  of  tho  Royal  College  of  Physicians  of  London,  Physician  to  the  Hmall  I'ox  nnd  VacclD- 
atlon  Hospital  at  High  Gato,  Corresponding  Mem  her  of  I  lie  National  Institute  of  W  nsh- 
Ington,  etc      First  American  Edition  with  numerous  additions  and  amend- 
ments by  the  Author,  Comprising  his  latest  views       With  Notes  and 
an  Appendix,  embodying  the  most  recent  opinions  on  Exnnlho- 
matlc  Pathology,  and  also  statistical  tables  and  colored  plates. 

By  n    D.  BULKLEY,  M   D., 

Physician  for  the  New  York  Hospital,  Fellow  of  tho  New  York  College  of  Physicians  n'A 
Surgeons,  etc.,  etc.     Price,  %i  JjO,  free  of  postage. 

"This  is  a  beautiful  volume,  and  got  up  in  the  most  attractive  style.  The  volume  contains 
the  fullest  and  most  comprehensive  account  of  that  most  Interesting  cla<-s  of  diseases,  the  I  '  - 
antbemnta,  to  be  met  with  in  a  single  volume  in  the  English  language  or  in  any  language.  We 
have  no  hesitation  in  saying  that  the  smallest  medical  library  is  most  Inmi  ntabiy  defei 
without  this  book,  and  whoever  procures  It  will  feel  that  it  Is  absolutely  Indispensable  to  the 
general  practitioner." — Niis/i/ville  Journal  of  Medicine  and  Surgery. 

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OPHTHALMIC    K'EMOEAKBA 

Respecting  those  Diseases  of  the  Eye  which  are  more  frequently  met  with  In 

Practice. 
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Oklo  Med.  and,  Surg.  Journal. 

THIRD  EDITION  OF 

Lectures  on  Materia  Medica  and  Therapeutics, 

Delivered  in  the  College  of  Physicians  and  Surgeons  of  the  University  of  the  State  cf  New 

York,  by 

JOHN    B.    BECK,    M.D., 

Late  Professor  of  Materia  Medica  and  Medical  Jurisprudence,  prepared  for  Vie  press  by 

his  friend, 

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»    Professor  of  Obstetrics,  <&&,  in  the  College  of  Physicians  and  Surgeons,  Neio  Yor/z. 
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confidence  of  the  profession,  so  thia." — Boston  Medical  and  Surcical  Jottmc^. 


iS.   S.  «$•   W    Wood's  Medical  Catalogue. 

An  ENTIRELY  NEW  AND  VALUABLE  WORK  oh 

Digestion   and  its    Derangements. 

The  Principles  of  Rational  Medicine  applied  to  Disorders  of  the  Alimentary  Canal 
BY    THOMAS    K.    CHAMBERS,    M.D. 

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terly Journal  of  Med.  Science. 

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Illuminate  every  page." —  Western  Lancet. 

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cian of  such  eminence  as  the  late  Dr.  Chambers,  who  is  not  so  much  notorious  for  having  ha<! 
for  years  the  largest  practice  in  England,  as  for  having  been  one  oi  the  most  diligent  cultivators 
of  pathological  medicine  in  the  United  Kingdom.  Verily  his  'decennium  pathologicum '  is  a 
monument  perewnius  auro  " — Medical  Chronicle. 

On  Rheumatism,  EJieumatie  Gout,  and  Sciatica; 

THEIR  PATHOLOGY,  SYMPTOMS,  AND  TREATMENT. 

BY  HENRY  WM.  FULLER,  M.D ,  CANTAB, 

Fellow  of  the  Royal  College  of  Physicians,  London,  &c,  &o. 

Price  $1  75,  free  of  postage. 

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"  A  valuable,  well-timed,  and  very  complete  monograph." — N.  O.  Med.  and  Surg.  Jour. 

"  A  highly  valuable  work  on  the  pathology  and  treatment  of  rheumatism." — Peninsular 
Jour,  of  Med. 

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Interesting  affection."— Georgia  Blister  and  Critic. 

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"  A  very  valuable  treatise  on  the  subjects  mentioned.  Decidedly  in  advance  of  any  other 
monograph  upon  the  different  forms  of  rheumatism." — Buffalo  Medical  Journal. 

"This  volume  must  rank  high  as  authority  upon  the  diseases  it  so  fully  and  ably  describes. 
It  is  s  capital  monograph,  and  well  deserving  of  a  prominent  place  in  every  library." — Net- 
tori's  American  Lancet. 

"  Worthy  of  a  ^lace  In  the  professional  library,  for  its  rich  record  of  cases,  its  abundant  sta, 
iiistlcs  of  rheumatism,  its  clear  statement  of  facts,  and  its  useful  suggestions." —  N.  Y.Daily  Times. 

"It  contains  a  morn  complete  description  of  rheumatism  in  its  maaifoli.  phases  and  relatioao 
%an  is  to  be  met  with  in  any  other  tr^ttse  on  toe  attbioet."— Medical  JSr,a  >n,ner. 


LECTURES 


MATERIA  MEDICA  AND  THERAPEUTICS, 


DELIVERED   IN   Till 


COLLEGE  OF  PHYSICIANS  AND  SURGEONS 


UNIVERSITY  OF  THE  STATE  OF  NEW  YORK. 


JOHN   B.   BECK,   M.D.; 

LATE  PROFESSOR  OF  MATERIA   MEDICA   AND   MEDICAL   JURISPRUDENCE. 
PREPARED  FOR  THE  PRESS  BY   HIS  FRIEND, 

C.    R.    GILMAN,    M.D;, 

PROFESSOR   OP  OBSTETRICS,   ETC.,   IN   TILE   COLLEGE    OF  PHYSICIANS   AND   SURGEONS,    N.   T. 


THIRD    EDITION. 


NEW    YORK: 

SAMUEL    S.    &    WILLIAM    WOOD, 
389    BROADWAY. 

1861. 


yte^U 


/r// 


Entered  according  to  Act  of  Congress  in  the  year  1851,  by 
A.    8.    BECK, 
In  the  Clerk's  Office  of  the  District  Court  of  the  United  States,  for  the  Southern  District 
of  New  York. 


It.  CRAIGHEAD,  Printer  and  Stereotyper, 
Caitort  BuilUing, 
81,  83.  and  85  Centre  st.,N.  T. 


alumni  nf  tyt  dfalleje 


PHYSICIANS      AND      SURGEONS 


ftliukrstii)  of  ijrt  £tak  of  gttfo  %mh 


Gentlemen  : 

I  dedicate  these  Lectures  to  you  in  the  hope  that  in  their 
present  shape  they  may  meet  with  a  portion  of  that  favor  with  which  you  received 

them  when  they  came  from  the  lips  of  the  Author. 

C.  R.  GILMAN. 


PREFACE  TO  THE  FIRST  EDITION. 


In  presenting  these  Lectures  to  the  friends  and  admirers  of 
the  late  Dr.  Beck,  and  especially  to  the  Alumni  of  the  College 
in  which  he  labored  so  long  and  so  faithfully,  a  -word  or  two 
explaining  my  own  connexion  with  them  seems  to  be  proper. 
After  the  death  of  my  friend  I  was  informed  that  he  had  partly 
prepared  his  Lectures  for  the  press,  and  I  was  requested  to 
look  at  the  papers  and  give  an  opinion  as  to  whether  they  were 
in  a  state  fit  for  publication,  and  if  so  to  prepare  them  for  the 
press.  With  this  request  I  felt  very  reluctant  to  comply. 
Quite  a  number  of  circumstances  seemed  to  me  to  point  out 
another  person  for  this  duty ;  and  for  myself,  I  felt  that  neither 
by  previous  study  nor  by  habits  of  thought  was  I  at  all  rea- 
sonably fitted  for  this  task.  There  existed,  indeed,  but  one 
reason  why  I  should  be  selected,  and  that,  having  undertaken 
the  duty,  I  have  placed  with  a  pride  deeply  mingled  with 
sorrow  upon  the  title-page.  We  were  friends.  For  twenty -five 
years  of  constant  intercourse,  no  shade  of  doubt,  distrust,  or  ill- 
feeling,  passed  between  us.  This,  and  deference  to  the  wishes 
of  one  whose  devotion  to  his  happiness  when  living,  is  only 
equalled  by  her  zealous  interest  in  his  fame  when  dead,  induced 
me  to  undertake  this  labor.  I  found,  on  examination,  that  on 
most  subjects  the  Lectures  had  been  re-written  with  apparent 
care  ;  on  others,  this  was  done  only  partially  ;  and  in  one  or  two 


VI  PREFACE   TO    THE   FIRST   EDITION. 

instances  the  leaves  of  the  old  Lectures  were  intermingled  with 
very  small  portions  of  the  new  manuscript.  Such  was  the  form 
in  which  these  Lectures  came  into  my  hands.  Though  well 
aware  of  the  great  amount  of  labor  which  the  preparing  of  such 
a  mass  of  matter  for  publication  would  involve,  I  did  not  shrink 
from  it ;  I  believed  that  the  Lectures  contained  a  valuable  digest 
of  the  present  state  of  knowledge  in  this  department,  and  that 
they  would  be  acceptable  to  the  profession  and  useful  to  medical 
students.  Whether  my  estimate  was  the  dictate  of  sound  judg- 
ment or  of  partial  friendship,  the  profession  into  whose  hands 
I  now  commit  the  work  will,  of  course,  decide  for  themselves. 
In  preparing  the  work  for  the  press  my  agency  has  been  merely 
ministerial.  Where  the  manuscript  was  re-written,  and  free 
from  verbal  inaccuracies,  it  passed  out  of  my  hands  untouched ; 
where  it  seemed  to  me  that  the  language  could  be  made  more 
clear,  verbal  alterations  have  been  made  ;  where,  as  happened  in 
a  very  few  instances,  a  fact  was  stated  inaccurately,  the  state- 
ment was  corrected  ;  further  than  this  I  did  not  feel  at  liberty  to 
go.  The  opinions  are  those  of  Dr.  Beck,  not  of  his  Editor. 
In  some  cases  these  opinions  are  contrary  to  those  which  I  have 
formed,  and  been  in  the  habit  of  teaching ;  still  they  were  his, 
and  I  did  not  attempt  to  modify  or  impugn  them.  In  a  few 
places  I  have  added  a  few  words  where  I  thought  by  doing  so 
I  could  make  the  book  useful  for  students :  in  all  cases  these 
additions,  une  illo  imputantur"  are  included  in  brackets.  To 
these  remarks  there  are  two  exceptions  of  sufficient  importance 
to  be  specially  noticed  and  explained.  On  examining  the  manu- 
scripts I  found  proof  of  a  fact  of  which  I  was  before  cognizant, 
viz.  that  on  many  of  what  are  called  the  "New  Remedies,"  Dr. 
Beck  did  not  lecture.  He  was  in  truth,  as  these  Lectures  in 
almost  every  page  will  prove,  not  a  runner  after  new  things ; 
his  study  was  much  more  into  the  indications  of  treatment,  the 
circumstances  modifying  the  operation  of  medicine,  and  those 
kindred  topics  which  I  should  call  the  philosophy  of  Materia 
Medica,  than  into  the  character  and  claims  of  new  and  fashion^ 
able  therapeutic  agents.  This  explains  the  fact  that  many  "  new 
things"  found  no  place  in  his  Lectures.     I  had  no  disposition 


PREPACK  TO  THE   FIEST   EDITION1.  Vn 

to  alter  them  :  in  this  respect  I  shared  his  opinions,  ;nnl  concurred 
heartily  in  his  plan  of  touching.  Still  there  wov  two  subji 
which  I  supposed  it  proper  to  introduce;  into  the  book,  although 
I  found  no  notice  of  them  in  the  Lectures.  One  was,  to  be  sure, 
a  new  and  fashionable,  and  a  most  extravagantly  vaunted  ag 
Cod  Liver  Oil;  still  it  appeared  to  me  that  in  a  matter  with 
which  the  mind  of  the  profession  is  at  present  so  much  occupied, 
something  ought  to  be  said.  I  have,  therefore,  prepared  an 
article  which  1  hope  may  not  be  useless.  The  other  subject  to 
which  I  referred  is  Anaesthetics.  These  agents  have  been  intro- 
duced during  the  period  of  Dr.  Beck's  failing  health,  and  he 
never  lectured  on  them.  He  knew  that  they  were  noticed 
incidentally  by  two  of  his  colleagues,  Dr.  Parker  and  m}rself, 
and  that  I  devoted  considerable  time  to  a  rather  full  considera- 
tion of  the  whole  subject ;  hence  he  felt  the  less  necessity  for 
treating  of  them.  When,  however,  his  Lectures  came  to  be 
presented  to  the  profession  "  in  a  book,"  and  especially  when 
they  were  offered  to  students  as  a  text  book  of  Materia  Medica 
and  Therapeutics,  it  was  obviously  proper  that  a  consideration 
of  those  agents,  whose  use  is  so  wide-spread,  and  whose  utility 
is  scarce  now  a  subject  of  doubt,  should  appear  in  it.  I  accord- 
ingly prepared  an  article  on  Anaesthetics,  in  which  I  have  tried 
to  do  justice  to  a  class  of  remedies,  the  introduction  of  which 
into  practice  is,  I  firmly  believe,  a  great  boon  to  humanity. 

In  conclusion,  I  have  to  acknowledge  valuable  assistance 
from  Professor  Lewis  C.  Beck,  in  the  revision  of  the  article  on 
Proximate  Principles ;  and  to  confess  my  own  obligations  for 
the  matter  I  have  added,  toJPereira,  whose  book,  a  great  store- 
house of  valuable  knowledge  in  the  whole  subject  of  Materia 
Medica,  I  have  consulted  with  confidence,  and  used  when  I 
needed  it  with  freedom. 


PREFACE  TO  THE  SECOND  EDITION. 


Ltf  preparing  this  edition  for  the  press,  the  editor  has  felt  it 
his  duty  to  make  only  such  changes  in  matters  of  detail  as  shall 
render  the  book  more  useful  to  students,  as  presenting  an  accu- 
rate view  of  the  present  state  of  knowledge  on  the  subject  of 
Materia  Medica.  It  is  the  boast  of  the  cultivators  of  Medical 
Science  that  theirs  is  in  a  pre-eminent  degree  a  progressive 
science;  hence  the  absolute  necessity  of  revising  Text  books 
from  time  to  time.  Such  revision  it  has  been  the  editor's  aim 
to  give  this  book.  As  to  those  great  principles  of  Therapeutics 
which  constitute  the  distinctive  merit  of  the  work,  they  remain 
untouched.  Time  can  only  serve  to  confirm  their  truth  and 
increase  their  value. 


PREFACE  TO  THE  THIRD  JEDITIOE 


The  Editor  is  again  called  to jthe  grateful  duty  of  revising  an 
Edition  of  Beck's  Materia  Medica.  »  That  such  a  book  should 
continue  for  so  many  years  the  text  book  of  Materia  Medica  is 
proof  that  our  science  is  becoming  more  settled,  and  in  a 
good  degree  certain.  In  this  Edition  few  changes  have  been 
made.  The  author  was  not,  and  the  Editor  is  not  a  vaunter  of 
New  Remedies ;  few  of  these  have  been  deemed  worthy  of  record 
in  a  book  which  claims  to  establish  new  principles  of  Therapeu- 
tics, and  give  the  best  means  of  putting  those  principles  into 
practice. 

New  York,  October,  1861. 


CONTENTS. 


Page 
Introduction 11 

Physiological  and  Therapeutical  Effects  of  Medicines,  14 

Modes  in  which  Medicines  may  be  brought  to  act  on  the  System,  18 

Circumstances  Modifying  the  Effects  of  Medicines,  24 

Classification  of  Medicinal  Agents,  28 

Combination  of  Medicines,  31 

Proximate  Principles        .         . 36 

Organic  Acids,  38 

Organic  Alkalies,  and  the  Allied  Substances,  41 

Oleaginous,  Resinous,  and  Bituminous  Principles,  44 

Alcoholic  and  Ethereal  Principles,  48 

Sugars  and  their  Congeners,  49 

Emetics * 52 

Effects  on  the  System,  54 

Various  Circumstances  Modifying  the  Effects,  57 

States  of  System  favorable  and  unfavorable  to  their  use,  61 

Mode  of  Administering,  63 

Combination,  91 

Application  in  the  Treatment  of  Diseases,  66 

Individual  Emetics,  79 

Cathartics 92 

Effects,  93 

Circumstances  Modifying  the  Effects,  97 

Mode  of  Administering,  99 

Therapeutical  Effects,  101 

Use  in  Particular  Diseases,  102 

Classification,  111 

Individual  Cathartics,  112 

Saline  Cathartics,  126 

Mercurial  Purgatives,  143 

Combinations,  145 

Anthelmintics    .  150 

Pules  for  the  use,  154 
Individual  Anthelmintics,  155 

Sialagogues 163 

Mercury,  163 

Its  Physiological  Effects,  164 

Practical  Applications  of  Mercury  in  the  Treatment  of  Diseases,  176 

Preparations  of  Mercury,  185 

Diaphoretics 193 

Effects,  193 

Pules  for  their  Application,  197 
Practical  Applications,  198 
Individual  Diaphoretics,  201 


X  CONTENTS. 

Page 
Expectorants 209 

Practical  Applications,  211 
Eules  for  Administration,  215 
■  Individual  Expectorants,  215 
Antispasmodic  Expectorants,  225 
Diuretics 228 

Effects,  228 

Application  in  the  Treatment  of  Diseases,  232 

Eules  for  Use,  235 

Individual  Diuretics,  235 

Emmenagogues 261 

Parturients 265 

Dangers  from  the  Use  of  Ergot,  268 
Sedatives 271 

Bloodletting  and  its  Effects,  271 

States  of  System  favorable  and  unfavorable  to  Bloodletting,  281 

Rules  in  Relation  to  Bloodletting,  294 

Therapeutical  Applications  of  Bloodletting,  295 

Other  Sedatives,  310 
Refrigerants 334 

Practical  Application  in  the  Treatment  of  Diseases,  339 

Demulcents 343 

Narcotics 355 

Effects,  356 

Opium,  its  Properties,  and  Use  in  the  Treatment  of  Diseases,  355- 
377 

Other  Narcotics,  377 
Anesthetics 394 

Effects,  395 

Rules  for  Administration,  397 

Applications  to  Disease,  393 

Individual  Anaesthetics,  401 
Stimulants 405 

Effects,  405 

Practical  Applications,  410 

Individual  Stimulants,  415 
Nervines 433 

Effects,  433 

Diseases  in  which  they  are  applicable,  434 

Individual  Nervines,  438 
Tonics 452 

Effects,  452 

As  Antiperiodics,  455 

Individual  Tonics,  457 

Astringents L^91 

Individual  Astringents,  495 
Revulsives ,  504 

Divided  into  five  Classes,  504 
Individual  Epispastics,  509 
Practical  Applications,  515 
Alteratives        ....  ......       517 

Application  to  Diseases,  518 
Individual  Alteratives,  520 
Local  Alteratives,  541 
Chemical  Alteratives,  547 


MATERIA    MEDICA 


T  H  E  RAPEUTIC  S. 


INTRODUCTION. 


By  the  Materia  Medica  is  meant  that  branch  of  Medical  Science 
which  treats  of  the  Instorv,  preparation,  properties,  and  effects  upon  the 
living  system,  in  health  and  disease,  of  the  various  agents  which  are  used 
for  the  prevention  or  cure  of  disease.  It  includes  two  distinct  depart- 
ments— viz.  First,  Materia^Medica^proper,  embracing  simply  an  account 
of  the  history  and  properties — physical  and  chemical — of  medicinal 
agents,  and  of  their  effects  on  the  system  in  bjjalth.  Second,  Therapeu- 
tics, That  which  relates  to  the  effects  of  these  agents  in  their  applica- 
tions to  the  management  of  disease.  It  is  in  this  extended  sense  that  I 
propose  to  consider  it  in  the  following  course  of  lectures ;  and  I  shall 
therefore,  besides  giving  you  a  description  of  the  various  properties  of 
medicines,  endeavor  to  lay  before  you  the  general  principles  which  are 
to  govern  you  in  their  use. 

There  are  several  points  of  view  in  which  medicines  are  generally 
considered  in  the  books — viz.  their  natural  history — their  physical,  their 
chemical,  and  finally,  their  therapeutical  properties. 

With  regard  to  the  natural  history  of  medicines,  it  is  not  my  inten- 
tion to  go  into  any  minute  botanical  or  mineral ogical  descriptions.  I 
shall  give  only  such  general,  concise  notices  as  may  be  more  immediately 
applicable  to  practical  purposes ;  referring  those  who  feel  an  interest  in 
the  subject  to  the  Dispensatories  for  fuller  information. 

Under  the  head  of  physical  properties  I  shall  call  attention  particu- 
larly to  such  circumstances  as  may  assist  in  ascertaining  the  purity 

2 


MATERIA   MEDICA   AND   THERAPEUTICS. 

of  the  article  as  used  in  medicine.  This  is  a  subject  of  great  importance, 
and  one  often  neglected.  To  those  who  know  to  what  an  extent  the 
adulteration  of  medicines  is  carried,  and  how  often,  from  this  cause,  the 
expectations  of  the  physician  are  frustrated,  it  will  scarcely  be  neces- 
sary to  say  anything  to  show  the  importance  of  such  knowledge  as  shall 
enable  the  practitioner  to  be  certain  that  he  is  really  giving  the  medi- 
cine which  he  has  ordered.  In  the  next  place,  of  their  chemical  proper- 
ties. A  knowledge  of  the  chemical  properties  of  the  medicines  is  no 
less  necessary  to  the  mere  practitioner  than  it  is  to  the  scientific  phy- 
sician. By  discovering  the  active  principles  of  vegetables,  it  has  ena- 
bled us  to  separate  them  from  inert  matter,  and  thus  not  merely  to 
improve  the  mode  of  their  administration,  but  to  increase  their  activity. 
For  a  striking;:  illustration  we  need  2:0  no  further  than  Peruvian  Bark. 
Whoever  compares  the  unwieldy  and  nauseous  doses  of  this  article  as 
formerly  given,  with  the  elegant  and  condensed  preparation  made  from 
it  in  the  form  of  the  sulphate  of  quinine,  must  at  once  admit  the  utility 
of  chemical  knowledge  as  applied  to  the  Materia  Medica.  In  addition 
to  this,  a  knowledge  of  the  chemical  properties  and  relations  of  medi- 
cinal substances  to  each  other,  is  the  only  thing  which  will  enable  the 
practitioner  to  avoid  that  very  great  though  common  error  of  giving 
articles  which  decompose  each  other,  and  either  neutralize  the  powers 
of  each,  or  produce  compounds  whose  effects  are  entirely  different  from 
those  intended. 

With  regard  to  the  Therapeutical  properties,  these  are  the  most  im- 
portant, and  they  shall  claim  the  principal  share  of  attention.  To  them 
a  knowledge  of  all  the  other  properties  is  only  subservient.  This  is  a 
part  of  our  subject  of  no  small  difficulty.  The  virtues  ascribed  to  medi- 
cines are  so  multifarious,  and  if  we  are  to  believe  the  reports  of  differ- 
ent writers,  so  positively  contradictory,  that  it  requires  the  soundest 
exercise  of  judgment,  connected  with  no  small  share  of  experience,  to 
decide  what  are  really  the  effects  of  medicines  upon  the  living  system, 
and  how  they  may  be  rendered  available  in  the  cure  of  diseases.  And 
as  we  cannot  in  all  cases  call  in  question  the  accuracy  of  the  statements 
of  distinguished  men,  however  contradictory  they  may  at  first  sight 
appear,  it  will  frequently  become  a  subject  of  philosophical  and  instruct- 
ive inquiry  to  investigate  the  causes  of  this  discrepancy.  Such  investi- 
gations are  worthy  of  the  highest  efforts  of  intellect,  as  their  object 
is  to  show  that  medicine  is  not  an  uncertain  art,  but  a  science,  built  upon 
fixed  and  rational  principle.  The  principles  upon  which  these  investi- 
gations will  be  conducted  are  exceedingly  simple.  Without  entering 
into  any  process  of  reasoning  to  establish  it,  the  proposition  may  be 
assumed,  that  under  similar  circumstances  the  same  medicines  will  produce 
similar  effects.  This  is  a  self-evident  proposition  ;  and  by  carefully  apply- 
ing it,  we  shall  be  able,  in  most  cases,  to  arrive  at  a  satisfactory  solu- 


INTRODUCTION.  ]  3 

tion  of  the  contradictory  accounts  which  arc  upon  record  in  relation  to 
the  effects  of  medicines.  In  all  cases,  therefore,  in  which  the  effects  of 
the  same  medicine  arc  reported  to  be  different,  the  first  question  to  be 
determined  is,  was  the  medicine  really  the  same  ?  From  the  ambiguity  of 
nomenclature,  and  the  fluctuations  which  it  has  undergone,  it  will  not 
unfrequently  be  found  that  the  same  term  has  been  applied  to  substances 
totally  different. 

Independently  of  this  general  error  resulting  from  the  confusion  of 
terms,  there  are  other  circumstances  which  require  investigation  to 
ascertain  the  character  of  medicines.  The  virtues  of  medicinal  vege- 
tables especially,  depend  much  upon  the  season  of  the  year  in  which 
they  are  collected — upon  the  part  of  the  plant  used — upon  the  mode  of 
preparation — upon  the  length  of  time  they  have  been  kept,  <fec,  <fcc. 
So  greatly  do  all  these  circumstances  modify  the  character  of  medicinal 
substances,  that  illustrations  might  be  given  in  abundance,  in  which, 
from  ignorance  or  inattention,  some  of  the  most  powerful  articles  in  the 
Materia  Medica  have  been  rendered  perfectly  inert.  Having  determined 
the  character  of  the  medicine  given,  the  next  subject  of  inquiry  is  to 
ascertain  the  circumstances  under  which  it  tvas  given.  Here  an  exten- 
sive field  of  investigation  opens  upon  us.  Was  the  disease  the  same  ? 
Diseases  passing  under  the  same  name  differ  essentially  in  their  general 
type  and  character.  What  was  the  stage  of  the  disease  ?  If  these 
questions  cannot  be  determined  with  some  degree  of  certainty,  it  is 
useless  to  object  that  the  medicines  are  uncertain  in  their  effects. 
Besides  these,  there  are  constitutional  differences  in-  patients  which 
modify  very  greatly  the  effects  of  remedies,  such  as  temperament,  ao-e, 
sex,  habits,  occupation,  <fec.  Now,  to  appreciate  justly  the  effects  of 
remedies,  all  these  circumstances  are  entitled  to  consideration,  and  in 
many  cases  they  will  lead  to  a  solution  of  the  contradictions  which  are 
found  in  medical  writers.  From  the  view  just  given,  it  is  evident  that 
the  Materia  Medica  presents  a  wide  field  for  practical  study  as  well  as 
philosophical  research.  In  general  interest  and  utility  it  yields  the  pre- 
cedence to  no  department  of  medical  knowledge.  In  the  circle  of  the 
sciences,  it  holds  a  most  important  station.  It  is  the  connecting  link 
between  strict  medicine  and  the  collateral  sciences,  Chemistry,  Botany, 
Mineralogy,  and  Geology ;  while  to  the  Therapeutical  part  of  it  every 
other  branch  of  medical  science  is  subservient.  In  conducting  a  course 
of  instruction  on  a  subject  so  important  my  object  will  be  :  First,  to 
spread  before  my  class  the  material  facts  and  principles  which  consti- 
tute the  science  of  the  Materia  Medica,  and  second,  to  give  such  a 
direction  to  your  minds  as  shall  encourage  you  to  think  and  reason  for 
yourselves.  Essential  as  is  the  first  of  these  objects,  it  is  far  exceeded 
in  importance  by  the  second.  There  is  no  science  which,  in  its  practi- 
cal   applications,  calls  for   such   incessant  exercise  of  the  reason  and 


14  MATERIA    MEDICA   AND   THERAPEUTICS. 

judgment  as  medicine ;  and  if  I  shall  be  so  fortunate  as  to  aid  in  any 
good  degree  those  who  hear  me,  in  disciplining  their  minds  to  habits  of 
thought  and  reflection,  my  highest  ambition  as  a  teacher  will  be  gra- 
tified. 

As  preliminary  to  the  consideration  of  medicines  in  detail,  it  will  be 
necessary  to  make  some  general  observations  in  relation  to  their  effects, 
as  well  as  the  various  modes  in  which  these  effects  are  propagated, 
throughout  the  system. 

Of  the  Effects  of  Medicines. — The  effects  of  medicines  are  divided 
into  two  classes — Physiological  and  Therapeutical.  By  the  first,  are 
meant  the  ordinary  immediate  effects  which  are  produced  on  the  system 
without  reference  to  disease.  By  the  second,  are  meant  those  _efj!ecis_ 
which  exhibit  themselves  in  the  alleviation  or  removal  of  the  various 
morbid  conditions  under  which  the  system  may  be  laboring.  Thus,  for 
example,  an  emetic,  if  given  a  short  time  before  the  expected  return  of 
a  paroxysm  of  intermittent,  will  frequently  prevent  it  altogether.  In 
this  case,  the  nausea  and  vomiting  which  the  emetic  produces  are 
physiological  effects ;  while  the  prevention  of  the  paroxysm  is  the 
therapeutical  effect.  Now,  the  distinction  between  these  effects  is 
obvious  and  important,  and  ought  always  to  be  kept  in  view.  At 
present  our  business  is  only  with  the  physiological  effects.  The  thera- 
peutical will  properly  come  to  be  considered  when  we  treat  of  the  ap- 
plication of  remedies  to  the  management  of  disease. 

Physiological  Effects. — These  are  divided  into  local&nd^remQte.  By 
the  first,  we  mean  those  impressions  which  the  medicine  makes  upon 
the  part  with  which  it  comes  in  immediate  contact.  By  the  second, 
those  which  are  the  consequence  of  the  local  ones,  and  which  show 
themselves  in  distant  parts  of  the  system. 

Of  the  Local  Effects. — In  general,  it  may  be  said  that  there  are 
two  ways  in  which  medicines  may  act  upon  the  part  to  which  they  are 
applied.  In  the  first  place,  chemically,  they  then  corrode  and  destroy 
it.  Ordinary  caustics  applied  to  the  surface  of  the  body,  furnish  an 
illustration  of  this  mode  of  action.  Second,  they  may  modify  the  vital 
properties  of  the  part.  The  modes  in  which  the  vital  properties  may 
thus  be  influenced,  are  various  both  in  kind  and  degree.  In  some  cases, 
the  sensibility  and  irritability  of  the  part  are  increased,  and  a  stimulant 
or  irritant  effect  is  produced.  Stimulants  of  various  kinds,  introduced 
into  the  stomach,  produce  on  the  mucous  membrane  of  that  organ  such 
an  effect.  So,  also,  in  a  still  more  striking  manner,  do  rubefacients  and 
blisters  applied  to  the  surface.  In  these  cases,  the  nerves  and  blood- 
vessels are  both  implicated.  That  the  nerves  are  affected,  is  evident 
from  the  heat  and  increased  sensation,  while  the  redness  and  distension 
show  the  effect  on  the  blood-vessels.  In  other  cases,  the  sensibility, 
and  irritability  of  the   part,  instead  of  being  increased,  are  impaired, 


INTRODUCTION'.  15 

and  then  a  sedative  effect  is  produced.  Here  the  impression  seems*  to 
be  limited  in  a  great  measure  to  the  nerves,  without  involving  materi- 
ally the  blood-vessels.  Of  this  mode  of  action,  opium,  aconite,  and 
other  narcotics  furnish  illustrations. 

In  other  cases,  again,  the  local  impression  amounts  to  nothing  more 
than  exciting  the  absorbent  vessels  to  which  they  are  applied.  This  is 
the  mode  of  action  of  many  of  those  articles  which  are  carried  into  ih1 
general  circulation,  and  whose  effects  are  manifested  only  in  the  relief 
of  morbid  conditions  of  the  system.  The  local  effects  of  the  same 
remedy  will  vary  : 

1st.  According  to  the  part  of  the  system  to  which  it  is  applied,  e.  g. 
when  applied  to  the  eye,  brandy  will  produce  a  very  different  effect 
than  when  introduced  into  the  stomach. 

2d.  According  to  the  state  of  the  part  at  the  time — e.  <j.  to  the 
inflamed  stomach,  the  effects  of  wine  are  very  different  from  those  to  the, 
stomach  in  health. 

The  remote  effects,  as  already  stated,  are  developed  in  different  parts 
of  the  system.  Like  the  local  effects,  they  differ  in  character — some 
are  stimulating  and  others  are  depressing — some  alterative.  Between 
the  local  and  remote  effects  it  is  important  to  remark  that  there  is 
no  necessary  similarity  in  the  nature  of  their  action.  A  medicine,  for 
example,  may  be  a  stimulant  to  the  part  to  which  it  is  applied,  and  yet 
depressing  to  other  parts  of  the  system.  An  emetic,  for  example, 
is  exciting  to  the  stomach  itself,  but  remotely  depressing  on  the  vascular 
system.  Colchicum  proves  irritant  to  the  stomach  and  bowels,  while  in 
its  remote  action  it  lowers,  very  strikingly,  the  circulation.  No  infer- 
ence, therefore,  can  be  drawn  from  the  local  action  of  a  medicine,  as  to 
its  remote  effects. 

These  differ,  also,  greatly  in  the  parts  of  the  system  where  they 
develop  themselves.  In  some  cases,  the  mucous  tissue  is  the  part  remote- 
ly affected,  as  is  shown  in  the  increase  or  diminution  of  its  secretions. 

In  some  cases  the  nervous  system  is  the  part  remotely  acted  on. 
Thus  opium  acts  locally  on  the  stomach  and  remotely  upon  the 
brain  and  nerves  of  the  system  generally. 

Sometimes  the  vascular  system  is  the  part  upon  which  the  remote 
impression  is  chiefly  developed.  Digitalis,  for  example,  acts  thus  in  a 
remarkable  manner  upon  the  heart  and  blood-vessels.  In  other  cases, 
again,  the  glandular  system  is  chiefly  affected.  In  this  way  mercury 
acts  upon  the  salivary  glands ;  iodine  on  the  breast,  thyroid,  and  other 
glands  of  the  system. 

In  a  great  number  of  cases  the  remote  effects  of  medicines,  instead  of 
being  thus  limited  to  particular  parts,  are  developed  in  several  conjoint- 
ly. Thus  mercury,  in  its  remote  agency,  involves  the  mucous,  the 
vascular,  the  nervous,  and  the  whole  glandular  system. 


16  MATERIA   MEDICA   AND   THERAPEUTICS. 

"Of  the  manner  in  which  these  Effects  are  produced. — With  regard  to 
the  local  effects,  our  knowledge  is  confined  within  very  narrow  limits. 
All  that  we  can  say  about  it  is,  that  the  medicine,  whatever  it  may  be, 
comes  in  actual  contact  with  a  living  surface,  and  produces  upon  it 
peculiar  effects  corresponding  to  the  nature  of  the  substance  applied 
and  the  particular  susceptibility  of  the  part  to  which  it  is  applied.  In 
short,  our  knowledge  does  not  extend  beyond  the  simple  expression  of 
the  fact  itself.  Huio  it  is,  or  why  it  is,  that  such  effects  are  produced, 
are  subjects  entirely  beyond  our  comprehension. 

With  regard  to  the  remote  effects,  the  question  which  presents  itself 
is  of  a  different  character — In  what  way  is  it  that  medicines,  when 
locally  applied,  are  capable  of  producing  effects  on  different  parts 
of  the  system  ?  How  is  it  that  agents  taken  into  the  stomach,  or 
applied  to  the  skin,  can  affect  the  brain,  the  lungs,  the  kidneys,  the 
uterus,  &c.  This  is  a  question  by  no  means  of  easy  solution,  and  has 
been  greatly  embarrassed  by  the  theories  and  speculations  of  ingenious 
men.  In  discussing  it,  I  shall  endeavor  to  keep  aloof  from  these 
theories,  and  confine  myself  to  such  views  as  may  be  sustained  by  fact 
as  well  as  argument. 

There  are  only  two  ways  in  which  different  parts  of  the  system  can 
hold  intercourse  or  be  acted  upon  by  one  another.  The  first  of  these  is 
through  the  medium  of  the  nerves  :  the  second  through  the  medium  of 
the  circulation.  It  is  only  in  one  or  the  other  of  these  two  ways,  there- 
fore, that  the  effects  of  medicinal  agents  can  be  produced  in  distant 
parts  of  the  system.  In  other  words,  the  impression  made  by  the 
medicine  upon  the  part  to  which  it  is  applied  must  be  conveyed  sympa- 
thetically by  reflex  action  to  other  parts ;  or  the  medicine  must 
be  takeu  into  the  circulation  and  actually  carried  to  different  parts 
of  the  system,  and  thus  produce  its  remote  effects.  A  candid  review  of 
all  the  facts  connected  with  the  subject  will  lead  us,  I  think,  to  the  con- 
clusion that  in  neither  of  these  modes  exclusively  are  the  remote  effects 
of  medicines  produced  ;  but  that,  while  in  some  cases  they  are  produced 
by  sympathy,  in  others,  and  that  the  very  great  majority,  they  are  the 
result  of  absorption  into  the  circulation  ;  and  these  are  the  points  which 
I  shall  endeavor  to  establish. 

In  the  first  place,  of  the  production  of  the  remote  effects  by  sympathy. 
The  human  system  is  so  constituted  that  no  part  of  it  is  completely 
isolated  from  the  rest.  Impressions  made  upon  one  portion  of  it  are 
extended  with  different  degrees  of  force  to  others.  An  incessant  inter- 
course is  thus  kept  up  throughout  the  complicated  machinery  of  the 
animal  economy,  and  the  agents  through  which  this  is  accomplished  are 
the  nerves.  Now  that  some  medicinal  agents  act  through  the  nervous 
system  is  beyond  doubt,  and  this  is  proved  not  so  much  by  the  rapid- 
ity with    which   these    effects  are  evolved,  though    that  was  formerly 


INTRODUCTION.  17 

much  relied  on,  as  by  the  character  of  the  agents  that  produce  them. 
Thus,  for  example,  ammonia  held  to  the  nostrils  almosj  immediately 
rouses  from    a  lit  of  fainttlig ;    ;i   feather   applied   to    the     ami    part 

causes  sneezing';   the  linger  in  the  fauces  causes  vomiting,  <V'\ 

Now  in  these  cases,  as  well  as  many  others  which  might  be  adduced, 
the  effect  is  doubtless  produced  through  nervous  agency.  Experiments 
made  upon  animals  with  certain  poisonous  agents  were  thoughl  to  -how 
this  in  a  still  more  conclusive  manner,  but  more  accurate  investigation 
has  robbed  the  argument  from  rapidity  of  action  of  all  its  force,  by 
proving  that  absorption  may  take  place  in  an  astonishingly  short  time — 
a  time  quite  within  that  in  which  the  most  violent  poisons  act.  Blake 
says.that  the  time  in  which  a  substance  may  be  absorbed  by  the  capil- 
laries, and  diffused  throughout  the  body,  may  not  exceed  nine  seconds. 
These  experiments  on  the  rapidity  of  absorption,  and  the  exposition  of 
the  mode  of  operation  on  the  reflex  system  of  nerves,  have  thrown  a 
flood  of  light  on  this  formerly  obscure  subject. 

In  the  second  place,  of  the  production  of  the  remote  effects  by  the  ab- 
sorption of  medicines  into  the  circulation.  In  the  investigation  of  this 
point  two  things  require  to  be  noticed.  1st,  Are  medicines  actually 
absorbed?  and,  2d,  Are  the  remote  effects  the  result  of  this  absorption? 
Strange  as  it  now  appears  to  ns  it  has  been  actually  denied,  and  that 
by  writers  of  authority,  that  medicines  are  ever  taken  into  the  circula- 
tion. The  proof,  however,  is  perfectly  conclusive,  and  no  one  now 
thinks  of  denying  that  medicinal  substances  are  taken  into  the  circu- 
lation. 

This  being  so,  another  point  remains  to  be  settled,  what  is  the  precise 
mode  in  which  their  effects  are  finally  produced  ?     The  prevailing  opi- 
nion is  that  the  medicine,  after  being  introduced  into  the  circulation,  is  • 
carried  to  different  parts  of  the  system,  and  produces  its  effects  by  actual 
contact  with  the  parts  or  organs  in  which  its  agency  is  developed. 

In  concluding  the  whole  subject  of  the  modus  operandi  of  medicines, 
the  propositions  which  in  the  present  state  of  our  knowledge  are  entirely 
defensible,  are 

1st,  That  medicines  differ  in  the  manner  in  which  their  effects  are 
produced. 

2d,  That  some  produce  their  effects  through  the  nerves  or  by  sym- 
pathy. 

3d,  That  some  are  absorbed  into  the  circulation  and  produce  their 
effects  in  consequence  of  such  absorption.  As  to  the  mode  in  which 
agents  introduced  into  the  general  mass  of  the  blood  come  to  affect  one 
organ  rather  than  another,  our  knowledge  is  very  limited  ;  we  can 
hardly  go  beyond  the  expression  of  the  fact,  that  certain  substances 
have  under  such  circumstances  a  tendency  towards  one  organ  rather 
than  another,  or  perhaps  that  one  organ  has,  as  a  part  of  its  peculiar 


18  MATERIA   MEDICA  AND   THERAPEUTICS, 

vitality,  a  special  susceptibility  to  be  affected  by  one  agent  when  that  is 
presented  to  it  in  the  blood. 

The  discussion  of  the  modus  operandi  of  medicines  is  not  a  mere  sub- 
ject of  speculation  ;.  on  the  contrary,  it  has  practical  bearings  of  great 
importance,  and  it  is  on  this  account  that  I  will  dwell  upon  it. 

1.  Medicines  are  modified  in  their  effects  by  a  great  variety  of  cir- 
cumstances, and  in  the  treatment  of  many  diseases  it  may  be  a  matter 
of  very  great  importance  to  determine  whether  the  medicine  which  may 
be  used  produces  its  effects  through  the  agency  of  the  nerves,  or  by 
being  absorbed  into  the  circulation.  In  many  diseases  the  fluids  are 
manifestly  changed  in  their  condition,  and  these  again  react  upon  the 
solids.  Is  it  unreasonable  then  to  suppose  that  medicines,  if  absorbed 
into  the  circulation,  must  exert  from  this  very  circumstance  some  pecu- 
liarity in  their  operation  ? 

2.  If  medicinal  substances  be  taken  into  the  circulation,  they  must 
impregnate  fluids  secreted  from  the  blood.  Now  milk  is  one  of  these  ', 
and  if  this  fluid  can  be  thus  impregnated,  the  sucking  child  must  inevi- 
tably become  affected.  BesidesT  if  it  can  be  proved  that  the  articles 
taken  into  the  stomach  are  introduced  into  the  milk,  it  must  necessarily 
modify  the  effect  of  it  even  as  an  article  of  diet,  and  may  thus  exert  a 
most  material  influence  over  the  whole  constitution  of  the  child.  In 
addition  to  all  this,  if  the  milk  can  be  thus  charged  with  medicinal 
agents,  it  may  be  found  exceedingly  useful  as  a  vehicle  for  adminis- 
tering certain  medicines  at  an  early  period  of  life,  by  giving  to  the 
mother. 

It  is  important  in  its  application  to  medical  jurisprudence.  It  has 
been  found  that  most  poisons  are  absorbed,  and  that  they  are  eliminat- 
ed from  the  system  mainly  through  the  urine.  If  this  be  so,  the 
urine  ought  to  indicate  their  presence.  Again,  in  the  treatment 
of  poisons,  if  they  pass  off  by  the  urine,  the  more  the  quantity  of  urine 
is  increased  the  more  likely  is  the  poison  to  be  passed  off  also.  Diu- 
retics, therefore,  are  a  class  of  remedies  which  may  be  made  very  useful 
here. 

You  perceive,  that  this  description  of  the  modus  operandi  of  medicines 
involves  a  great  many  points  of  great  practical  importance. 

Of  the  various  parts  of  the  Body  to  which  Medicines  are  applied. — 
There  are  three  different  modes  in  which  medicines  may  be  brought  to 
act  on  the  system,,  viz.  by  applying  them  to  some  portion  of  the  mucous 
membrane,  by  applying  them  to  the  skin,  and  lastly,  by  injecting  them 
into  the  veins. 

Of  the  Application  of  Medicines  to  the  Mucous  Membrane. — Almost 
every  part  of  this  membrane  may  be  made  the  seat  of  medical  applica- 
tion, and  in  every  case  important  effects  may  be  produced.  In  the 
relative  value  and  extent  of  these  effects,  however,  there  is  a  wide  differ- 


INTRODUCTION.  I  9 

enco,  according  to  the  part  of  the  membrane  to  which  the  medicim 
applied. 

The  Mucous  Membrane  of  the  Stomach. — This  is  the  surface  to  w  trich 

medicines  are  usually  applied,  and  from  whirl:  <;ffeets  an-  ol.iain.'d,  .-,-  n 
general  rule,  more  prompt  and  important  than  when  applied  to  any 
other  part.  The  reason  is  obvious.  Abundantly  supplied  with  nerves, 
a  primary  impression  may  here  be  made  with  great  effect.  Placed,  too, 
in  the  very  centre  of  the  system,  and  holding  the  most  direct  and  con- 
stant intercourse  with  all  the  important  organs  of  the  body  by  means 
of  its  nervous  communications,  the  stomach  possesses  a  power  of  trans- 
mitting impressions  unequalled  by  any  other  part.  Besides  this,  it  is 
supplied  with  a  profusion  nfjdwtrhing  vessels,  through  whose  agency 
substances  may  be"ihtrocl need  into  the  circulation,  and  thus  carried  to* 
the  remotest  parts  ;  over  and  above  all  this,  it  is  the  simplest  and  readiest 
mode  of  introducing,  medicines  into  the  system.  It  is,  therefore,  gene- 
rally resorted  to,  and  in  describing  the  effects  of  medicines,  it  is  always 
to  be  understood  that  this  is  the  mode,  unless  the  contrary  be  stated. 
The  doses  of  medicines,  too,  are  always  stated  in  reference  to  this  mode. 

The  Mucous  Membrane  of  the  Large  Intestines. — To  this,  medicines 
are  also  frequently  applied,  and  with  great  effect.  It  possesses,  however, 
less  sensibility  than  the  mucous  membrane  of  the  stomach,  and  therefore 
requires  a  larger  dose  of  the  medicine  to  produce  the  same  amount  of 
effect,  as  absorption  is  less  active.  Notwithstanding  all  this,  medicines 
when  applied  here  act  with  great  efficiency,  and  not  merely  the  local  but 
the  remote  effects  are  obtained  in  the  same  way  as  when  they  are, 
applied  to  the  stomach. 

The  Mucous  Membrane  of  the  Nostrils. — Medicines  are  sometimes 
applied  to  the  surface  and  make  a  powerful  impression,  not  merely  upon 
the  part  itself,  but  extend  their  effects  to  other  parts  of  the  system. 
The  vapor  of  ammonia,  by  the  impression  which  it  makes  on  the  nerves 
of  smell,  produces  a  general  effect  upon  the  whole  system. 

The  Mucous  Membrane  of  the  Lungs. — The  only  way  in  which 
medicines  can  be  applied  here  is  by  inhalation  in  the  form  of  vapor, 
and  as  a  general  rule,  the  object  had  in  view  is  to  obtain  their  local, 
effect  upon  the  part  itself,  and  they  are  employed  for  the  correction  of 
certain  morbid  conditions  of  this  membrane.  Notwithstanding,  it  is 
quite  certain  that  impressions  thus  made,  may  be  extended  to  other 
parts  of  the  system. 

The  attention  of  the  profession  has  been  very  strongly  directed  to 
this  mode  of  administering  medicines  by  the  general  use  of  Anaesthetics, 
but  of  them  hereafter. 

Besides  the  foregoing,  there  are  other  portions  of  the  mucous  mem- 
brane to  which  medicines  are  continually  applied,  such  as  the  eye,  the 
ear,  the  urethra  and  bladder,  the  vagina  and  uterus.     In  all  these  cases, 


20  MATERIA  MEDICA   AND   THERAPEUTICS. 

however,  the  only  object  is  to  obtain  certain  local  effects  from  the 
remedies,  though  the  remote  or  so  called  constitutional  effects  may 
follow,  as  for  example,  Belladonna  has  produced  its  constitutional  effects 
■when  applied  to  the  os  uteri  to  favor  dilatation. 

2.  The  next  Mode  of  bringing  Medicines  to  act  on  the  System,  is  by 
applying  them  to  the  Skin. — Blisters,  rubefacients,  frictions,  cold  and 
warm  bathing,  &c,  all  produce  their  effects  in  this  way.  Moreover, 
many  medicines  usually  introduced  into  the  stomach,  may  be  made  to 
produce  all  their  ordinary  effects,  by  applying  them  to  the  surface,  and 
this  is  frequently  a  mode  of  great  value.  The  skin  is  an  extensive  sur- 
face, plentifully  supplied  with  nerves,  and  hence  possessing  great  sensi- 
bility. It  is  capable,  therefore,  of  receiving  the  primary  impressions  of 
medicines.  An  objection  to  the  use  of  medicines  in  this  way  arises 
from  the  greater  density  of  the  epidermis  as  compared  with  the  epithe- 
lium ;  this  modifies  external  impressions,  and  delays,  though  it  does  not 
prevent,  absorption.  To  obviate  this  difficulty,  two  methods  are 
resorted  to — the  one  is  to  overcome  it  by  frictions,  so  as  to  bring  the 
medicine  in  contact  with  the  sensitive  portion  of  the  skin ;  the  other  is 
to  remove  the  cuticle  altogether  by  means  of  a  blister,  so  as  to  enable  us 
to  apply  the  medicine  to  the  denuded  surface.  The  first  of  these 
methods  is  called  the  IatroUptic  method,  the  other  the  Endermic 
method. 

latroleptic  method. — This  consists  in  the  application  of  medicines  by 
means  of  friction  to  the  skin.  That  some  medicines  applied  to  the  skin 
by  friction  are  capable  of  producing  the  same  effects  as  when  taken  into 
the  stomach,  is  a  fact  well  known.  Thus,  mercury  rubbed  in  the  form  of 
ointment  on  the  surface,  produces  salivation  with  as  much,  if  not  more 
certainty  and  rapidity,  than  the  internal  administration  of  the  metal. 
Frictions  with  ointment  of  gold  will  produce  all  the  specific  effects  of 
that  metal  on  the  system.*  A  strong  decoction  of  tobacco  rubbed  on 
the  epigastric  region,  or  on  the  skin  of  the  head,  will  cause  nausea  or 

*  Castor  oil,  applied  to  the  abdomen  by  friction,  according  to  Sigmond,  will 
affect  the  bowels  the  same  as  if  taken  internally,  especially  if  aided  by  the  warm 
bath.  He  states  that  "  obstinate  constipation  has  yielded  to  this  remedy,  and 
where  such  violent  and  constant  sickness  has  been  present  as  to  preclude  the 
possibility  of  the  internal  administration  of  the  oil,  it  has  produced  all  its  good 
effects  without  adding  to  the  distressing  state  in  which  the  stomach  is  found.  I 
have  seen,  by  these  means,  an  action  produced  upon  the  bowels  within  a  quarter 
of  an  hour  after  the  friction  has  been  employed,  immediately  on  the  patient  leav- 
ing a  bath  of  a  temperature  of  98°,  where  calomel,  jalap,  neutral  salts,  and  lave- 
ments had  failed  to  relieve  the  intestinal  canal,  and  when  constant  vomiting  had 

commenced,  and  all  idea  of  internal  remedy  had  necessarily  been  abandoned." 

Johnson's  Journal,  vol.  xxvi.  p.  493. 

Croton  oil,  it  is  also  asserted,  will  produce  its  usual  effects  on  the  bowels,  parti- 
cularly if  combined  with  castor  oil. — Ibid. 


INTRODUCTION.  '21 

vomiting.  Belladonna  or  Btraraonium  rubbed  on  the  eyebrow  will 
dilate  the  pupil  as  certainly  as  when  taken  inwardly.  Tincture  of 
cinchona  rubbed  on  the  spine  has  cured  intermittent  fever,  when  the 
internal  exhibition  of  it  has  failed.*  Digitalis  ami  squills,  too,  rubbed 
on  the  skin,  have  excited  the  action  of  the  urinary  organs  and  cured 
dropsy. 

The  foregoing  facts  are  sufficient  to  show  that  by  friction  on  the  sur- 
face, the  effects  of  certain  medicines  may  be  fully  obtained  on  the  syst<  m 

Endermic  method. — This  practice  consists  in  first  removing  the  cuticle 
from  a  portion  of  the  skin,  and  then  applying  medicines  to  the  denuded 
surface.  This  method  is  of  recent  origin,  and  we  are  indebted  for  it  to 
M.  Lambert,  by  whom  it  was  first  practised  in  one  of  the  French  hospi- 
tals, in  1828.f  In  this  method,  the  first  thing  to  be  done  is  to  separate 
the  cuticle.  The  best  mode  of  doing  this  is  by  the  application  of  a  com- 
mon blister  of  moderate  size,  say  about  four  inches  square.  The  only 
objection  to  it  is  the  length  of  time  which  tt  takes  to  blister.  When  it 
is  desirable  to  apply  the  medicine  as  speedily  as  possible,  the  cuticle 
may  be  separated  by  the  use  of  a  pomade  made  of  equal  parts  of  lard 
and  strong  liquor  ammoniae.J  By  renewing  this  every  five  minutes,  a 
blister  will  speedily  be  raised.§ 

The  best  part  of  the  body  for  making  the  application  is  the  epigas- 
trium. Having  separated  the  cuticle,  the  medicine  is  applied  in  the 
state  of  fine  powder,  or  if  it  be  too  irritating,  incorporated  with  cerate  or 
lard.  Applied  in  this  way,  a  number  of  agents  have  been  found  to 
produce  all  their  ordinary  effects  on  the  system.  Among  them  are  the 
sulphate  of  quinine,  the  acetate  and  sulphate  of  morphine,  strychnine, 
belladonna,  stramonium,  hyosciamus,  aconitine,  aloes,  gamboge  and  colo- 
cynth,  squill  and  digitalis. 

From  the  experiments  which  have  been  made,  it  will  appear  that 

*  Broussais  cured  intermittent  fever  in  this  way.  Phlegmasia},  vol.  ii.  p.  242. 
See  also  on  the  effects  of  the  external  application  of  bark,  Dr.  H.  Jackson  in  Cald- 
well's Theses  for  1806,  p.  173;  also  Dr.  S.  Pye,  in  Load.  Med.  Obs.  and  Inq.  voL 
ii.  p.  245. 

f  Essays  sur  la  Methode  Endermique  par  Ant.  Lambert.     Paris,  1828. 

|  Johnson's  Journal,  vol.  xxii.  p.  176. 

§  Where  an  instantaneous  blister  is  required,  the  following  has  been  recom- 
mended: "Cut  a  piece  of  cotton,  linen,  or  of  paper,  of  the  size  and  shape  for  which 
it  may  be  required ;  immerse  this  in  spirits  of  wine,  in  strong  brandy,  or  in  eau 
de  Cologne ;  lay  it  on  the  surface  to  be  blistered,  wiping  the  edges  so  that  none 
of  the  fluid  may  moisten  the  surrounding  parts ;  apply  a  lighted  candle  rapidly 
over  the  whole  surface,  that  it  may  be  burnt  immediately.  The  ignition  is  exceed- 
ingly quick,  and  the  cuticle  will  be  found  separated  from  the  subjacent  cutis." — 
Johnson's  Journal,  vol.  xxvL  p.  494. 

Ou  the  endermic  method,  see  also  British  and  Foreign  Review,  vol.  v.  p.  343.  Lon. 
Med.  Gazette,  Nov.  1838,  p.  233.  Dunglison's  Intelligencer,  vol.  iii.  p.  50.  Mad- 
den on  Cutaneous  Absorption,  p.  138. 


22  MATERIA   MEDICA    AND   THERAPEUTICS. 

medicines  applied  in  this  way  act  as  promptly  as,  and  sometimes  more 
so  than,  -when  taken  internally.  Frequently,  too,  they  do  not  require 
to  be  used  in  larger  doses,  though  they  generally  require  double  the  dose. 
A  great  objection  to  this  mode  is,  that  it  sometimes  produces  a  good 
deal  of  local  irritation,  causing  painful  and  tedious  sores.  This  I  have 
witnessed  myself  in  some  of  the  first  experiments  which  I  made  at  the 
New  York  Hospital  with  the  sulphate  of  quinine. 

[Many  of  the  substances  above  noted  produce,  even  when  diluted, 
extreme  pain,  and  they  should  be  used  in  delicate,  nervous  subjects,  with 
great  caution ;  especially  are  they  likely  to  do  harm,  in  children.  I 
have  known  at  least  one  case  of  fatal  convulsions  produced  in  this  way. 
—Ed.] 

3.  Injecting  into  the  veins. — This  is  the  last  mode  of  introducing 
medicines  into  the  system  that  requires  notice.  The  first  person  who 
made  any  attempts  at  ascertaining  the  effects  of  medicines  introduced 
into  the  veins  appears  to  have  been  Dr.  Wren, — then  of  Oxford.  As 
early  as  the  year  1665,  he  made  experiments  upon  dogs  by  injecting 
into  the  veins  of  the  hind  legs  opium  and  the  crocus  metallorum.  The 
dog  in  whom  the  opium  was  injected  was  stupified,  but  did  not  die.  In 
the  other  vomiting  and  death  were  the  consequences.*  About  two 
years  afterwards  experiments  of  a  similar  character  were  made  at  Pisa, 
by  Frascati.  Some  of  the  mineral  acids  were  injected  into  the  veins  of 
dogs.     These  proved  fatal. 

The  first  attempt  made  to  inject  medicines  into  the  veins  of  the  hu- 
man subject  appears  to  have  been  made  about  166*7  by  Dr.  Fabritius  of 
Dantzick.  The  experiments  were  made  upon  three  individuals — one 
male  and  two  females — by  injecting  into  the  vein  of  the  right  arm  a 
laxative  solution.  In  all  of  them,  a  purgative  effect  was  produced  on 
the  bowels,  besides  which  they  vomited  freely.  Two  did  well ;  one  of 
the  females,  on  the  day  following  the  operation,  took  cold  from  exposure 
and  died.f  In  the  next  year,  1668,  Smith,  a  physician  of  Dantzick, 
experimented  upon  two  venereal  patients,  by  introducing  alterative  medi- 
cines into  the  veins.  One  of  these  died,  the  other  recovered.  The 
same  experiments  were  tried  the  same  year  upon  three  other  patients — 
one  laboring  under  the  gout,  another  apoplexy,  and  a  third  plica  polo- 
nica — all  are  said  not  only  to  have  borne  the  operation  well,  but  to 
have  been  cured  of  their  respective  complaints/]; 

These  were  the  earliest  experiments  of  the  kind  made,  and  they  cer- 
tainly show  that  medicines  may  be  injected  into  the  veins  both  of  man 
and  of  animals  without  proving  fatal,  and  that  their  effects  may  be  pro- 

*  Hale's  Boylston  Prize  Questions,  p.  12. 

f  Philosophical  Trans,  for  1667.     Hale,  p.  14. 

%  Hale,  p.  76. 


INTItOTHJCTION.  23 

duced  upon  the  system.  Since  then  various  oilier  experiments  b 
been  made  with  the  same  view.  [n  1823,  Magendie  injected  «;irm 
water  into  the  veins  of  a  patient  at  the  Hotel  Dieu,  laboring  under 
hydrophobia.  It  had  the  effect  of  quieting  the  spasms,  but  he  never- 
theless died  at  the  end  of  some  days.  The  same  was  tried  in  three 
other  patients.  In  all  it  arrested  the  convulsions,  without  however 
saving  the  patients.* 

Still  more  recently,  aqueous  and  saline  fluids  have  been,  in  large 
quantities,  injected  into  the  veins,  and  in  a  few  cases  with  apparent 
advantage,  in  Asiatic  cholera. 

From  all  these  experiments  it  appears  that  medicines  may  be  intro- 
duced into  the  veins — and  that  they  produce  the  same  effects,  and  even 
more  promptly,  as  when  taken  into  the  stomach.  Nevertheless,  the 
practice  is  attended  with  too  much  danger  to  be  resorted  to  except  in 
very  extraordinary  cases. 

Relative  value  of  the  different  modes  of  introducing  medicines  into  the 
systeyn, — Having  noticed  the  different  modes  in  which  medicines  may 
be  brought  to  bear  upon  the  system,  I  shall  make  a  remark  or  two 
upon  their  comparative  value.  As  a  general  rule  there  can  be  no  ques- 
tion that  the  ordinary  mode  of  introducing  medicines  into  the  stomach 
is  in  every  respect  the  best.  Both  the  local  and  remote  effects  of  medi- 
cines are  produced  more  naturally  and  easily  in  this  way  than  in  any 
other.  There  is  less  trouble  and  inconvenience  attending  the  adminis- 
tration, matters  of  no  small  importance.  For  ease  and  safety,  then,  this 
is  to  be  preferred  as  a  general  practice.  Cases  and  occasions,  however, 
may  occur  in  which  some  of  the  other  modes  are  to  be  preferred.  Such 
for  instance  as  the  following: — 1.  When  the  stomach  will_not_jetain 
medicines,  and  they  are  rejected  by  vomiting,  _or  are  passed  by___the 
bowels.  A  familiar  instance  of  this  is  met  with  in  using  mercury  as  an 
alterative.  It  frequently,  even  when  combined  with  opium,  causes  such 
a  free  action  on  the  bowels  as  to  interfere  with  its  effects.  In  this_case 
introducing  it  by  friction  on  the  surface  is  a  most  valuable  and  certain 
resource.  2.  When  some  physical  obstruction  to  swallowing  occurs. 
3.  When  some  peculiar  idiosyncrasy  prevents  the  taking  of  medicines 
by  the  stomach.  4.  In  some  cases  in  children  from  the  difficulty  of 
getting  them  to  swallow  medicines. 

In  all  these  cases  the  external  application  may  be  suitable  and  pre- 
ferable. Of  the  different  modes  of  applying  them  externally,  the  Iatro- 
leptic  may  be  preferable  in  some  cases,  and  the  endermic  in  others. 
This  must  be  determined  by  the  nature  of  the  case  and  the  character  of 
the  remedy  to  be  applied.  With  regard  to  injecting  medicines  into 
the  veins,  it  is  a  practice  attended  with  too  much  hazard  to  warrant  its 

*  Diet.  Mat.  Med.,  vol.  iii.  p.  610. 


24  MATERIA   MEDICA   ANT>  THERAPEUTICS. 

adoption,  except  in  cases  of  diseases  intractable  to  the  ordinary  modes 
of  treatment — such  as  hydrophobia,  tetanus,  and  the  like. 

Of  the  various  circumstances  modifying  the  effects  of  medicines, — The 
human  system  is  not  always  the  same.  It  differs  at  different  periods  of 
life,  in  different  climates,  and  under  various  circumstances.  It  is  very 
evident,  therefore,  that  the  impressions  made  upon  it  must  also  vary. 
In  making  out,  therefore,  a  full  and  complete  history  of  the  effects  of 
medicinal  agents,  it  becomes  necessary  to  analyse  in  detail  all  the  cir- 
cumstances which  have  an  influence  in  modifying  the  condition  of  the 
system. 

1.  Age, — This  modifies  the  condition  of  the  human  system,  and,  of 
course,  the  effects  of  medicinal  agents.  In  infancy  all  the  textures  are 
exceedingly  delicate,  and  much  more  easily  affected  by  impressions 
made  upon  them  than  at  any  subsequent  period.  This  is  particularly 
the  case  with  the  mucous  membrane  and  the  skin,  the  two  surfaces  to 
which  all  medicinal  agents  are  applied.  The  brain  and  nervous  system, 
too,  are  more  delicate,  and  exercise  a  more  predominating  influence 
over  every  other  part  of  the  body.  Hence  it  is  that  the  brain  is 
so  easily  excited  by  irritations,  and  that  convulsions  and  organic  dis- 
eases of  this  organ  are  so  common  at  this  early  period.  The  vascular 
system,  too,  is  now  in  a  condition  entirely  different  from  what  it 
afterwards  comes.  Not  merely  is  the  power  of  the  heart  and  blood- 
vessels much  less,  but  there  exists  a  great  difference  in  the  relative  size 
of  the  arteries  and  veins,  as  well  as  in  the  quantity  of  blood  which  they 
circulate.  In  advanced  life,  in  all  these  respects,  the  system  has  under- 
gone a  complete  revolution.  The  tissues,  from  being  soft  and  delicate, 
become  dense  and  firm — their  sensibility  and  the  activity  of  their 
functions  are  lessened.  The  brain  and  nerves,  from  being  soft,  become 
firm  and  solid — their  functions  are  impaired,  sensation  is  blunted, 
and  all  the  motions  impeded.  Hence  pain  can  be  much  better  borne  in 
old  age  than  in  infancy.  The  blood-vessels,  too,  now  become  more 
solid,  in  many  cases  even  ossified,  and  the  venous  blood  in  the  system 
bears  a  much  larger  proportion  to  the  arterial  than  it  did  at  pre- 
vious periods,  and  venous  congestions  are  common.  From  all  this  it 
is  very  evident  that  the  system  undergoes  a  great  change,  and  it  would 
seem  as  a  matter  of  course  that  the  effects  of  agents  applied  to  it  must 
be  greatly  modified  by  these  changes,  and  such  indeed  is  proved  to 
be  the  case  by  observation  and  experience.  Almost  every  medicinal 
agent  is  more  or  less  modified  in  its  operation  according  to  the  period  of 
life  at  which  it  is  administered.     For  example  : 

Emetics  are  given  at  all  ages,  and  yet  how  different  are  their  general 
effects.  In  infancy  vomiting  is  excited  with  little  or  no  difficulty,  and 
so  far  as  the  mere  mechanical  process  is  concerned,  attended  with 
no  danger.       If,  however,  some  active  article  be  used,    even  in  doses 


INTRODUCTION".  25 

suitable  to  the  ago,  the  consequences  may  be  fatal.     Tartar  emetic 
thus  been  known  to  produce   vomiting    which    ended    in    death.     In 
advanced   life,   on    the   other   hand,  from    (he    impaired  sensibilitj    of 
the  organs  concerned,  vomiting  is   not   bo    readily    excited,  while  the 

mechanical  process,  which  in  children  is  attended  with  no  dai  ■■  r, 
is  now  frequently  destructive  of  life,  owing  to  the  tendency  which  there 
exists  at  this  period  to  venous  congestion  of  the  brain. 

Cathartics  afford  a  second  illustration.  In  early  life,  as  a  general 
rule,  this  class  of  medicines  operates  much  more  readily  than  they 
do  afterwards.  As  we  advance  in  years,  the  intestines,  in  consequence 
of  their  repeated  stimulation,  have  their  sensibility  impaired  and 
their  contractile  power  lessened,  and  cathartics  make  less  impression  ; 
accordingly,  they  require  to  be  used  in  much  larger  closes,  and  the  more 
active  articles  selected.  On  the  other  hand,  it  is  to  be  recollected 
that  the  intestines  of  children  are  more  liable  to  be  lined  with  col- 
lections of  viscid  mucus;  and  when  this  is  the  case,  they  can  bear 
much  larger  proportional  doses. 

Opium  furnishes  another  illustration.  While  to  adults  this  drug 
may  be  given  with  perfect  safety,  in  its  effects  upon  children  there 
is  frequently  nothing  so  uncertain.  Not  nnfrequently  the  simplest 
preparations  of  it,  administered,  too,  in  reasonable  doses,  have  been 
attended  by  alarming  and  even  fatal  symptoms.  The  syrup  of  poppies 
and  Paregoric  have  both  operated  occasionally  in  this  way. 

I  shall  notice  only  one  other  illustration,  and  that  is  Venesection. 
This  is  a  remedy  resorted  to,  and  very  properly,  at  all  ages ;  and 
yet  in  many  cases  it  is  to  be  feared  without  due  regard  to  the  dif- 
ference of  effect  produced  by  it.  As  a  general  rule,  children  do  not 
bear  the  loss  of  large  quantities  of  blood  so  well  as  adults.  One  or  two 
bleedings  they  may  bear,  if  carried  any  further  they  sink  under  it, 
Nor  do  they  recover  from  syncope,  when  induced  by  venesection, 
so  readily  as  adults.  On  the  contrary,  such  is  the  deficient  reaction  in 
them,  that  this  state  is  always  attended  with  more  or  less  danger.  In 
old  age,  the  same  general  rule  holds  good.  Moderate  quantities  of 
blood  may  be  abstracted  with  beneficial  effect,  while  the  loss  of 
large  quantities  is  followed  by  great  prostration  of  the  powers  of  life. 

The  foregoing  illustrations,  selected  from  a  thousand  others,  which 
might  be  adduced,  are  abundant  to  show  the  importance  of  investigating 
the  effects  of  remedies  at  different  periods  of  life.  Unless  this  be  done, 
it  is  idle  to  suppose  that  they  can  be  properly  or  even  safely  employed 
in  the  treatment  of  the  various  diseases  to  which  the  human  frame, 
from  infancy  to  old  age,  is  liable. 

2.  Sex. — This  modifies  very  greatly  the  condition  of  the  human 
system,  and  it  must  therefore,  also,  as  a  matter  of  course  modify 
the  effects  of  medicinal  agents.     As  a  general  rule,  the  constitution  of 


26  MATERIA   MEDICA    AND   THERAPEUTICS. 

females  is  much  more  delicate  than  that  of  males.  Their  nervous  sys- 
tem is  also  much  more  excitable.  Hence  impressions  are  more  easily 
made  upon  them  by  medicinal  agents.  The  more  active  articles  accord- 
ingly require  to  be  used  with  much  greater  caution  in  them.  In  vene- 
real hospitals  it  has  been  observed  that  only  half  the  quantity  of  mercury 
]s  necessary  to  produce  precisely  the  same  effect  as  in  males.  Indepen- 
dently of  the  general  delicacy  of  constitution,  there  is  another  circumstance 
attending  the  female  which  greatly  modifies  the  effect  of  remedies,  and 
that  is  a  state  of  pregnancy.  During  this  state,  women  bear  blood-let- 
ting much  better  than  at  any  other  period  ;  for  the  purpose  of  subduing 
disease,  it  is  frequently  necessary  to  carry  it  to  a  much  greater  extent 
than  under  the  ordinary  conditions  of  the  system.*  Tonics,  on  the  other 
hand,  are  not  borne  so  well,  and  do  not  appear  to  produce  precisely  the 
same  effects.  The  Peruvian  bark,  accordingly,  very  frequently  fails 
under  these  circumstances  to  arrest  the  paroxysms  of  intermittent  fever. 
In  the  advanced  stages  of  pregnancy,  the  use  of  emetics  is  frequently  fol- 
lowed by  a  premature  expulsion  of  the  foetus. 

3.  Peculiar  Habit  and  Constitution  of  Body. — This  modifies  very 
greatly  the  effects  of  remedies.  Ceteris  paribus,  fat  persons  are  vomited 
with  more  facility  than  lean  ones.  As  a  general  rule,  fat  persons  have 
less  blood  in  proportion  than  lean  ones,  and  on  that  account  do  not 
bear  the  loss  of  such  large  quantities.  In  delicate  and  irritable  habits, 
blisters  cause  a  great  degree  of  nervous  and  vascular  excitement,  attend- 
ed not  unfrequently  with  the  most  distressing  effects  on  the  system  at 
large.  There  is,  perhaps,  no  medicine  which  shows  in  a  more  striking 
manner  the  modifying  effects  of  temperament  than  mercury — an  article 
which,  in  robust  constitutions,  may  be  given  with  impunity,  in  nervous 
and  irritable  habits,  especially  if  carried  to  any  extent,  is  followed  by 
effects  the  most  disastrous,  augmenting  general  irritability,  and  predis- 
posing the  system  to  the  invasion  and  development  of  various  and  even 
fatal  diseases. 

4.  Climate  and  Season. — By  the  powerful  effect  which  these  exercise 
upon  the  human  frame,  they  exert  a  modifying  influence  on  the  effects 
of  remedies.  So  fully  was  the  celebrated  Baglivi  impressed  with  the 
truth  of  this,  that  he  frequently  adds,  in  giving  an  account  of  his  treat- 
ment, "  Vivo  et  scribo  in  ^Ere  Romano."  Celsus  has  observed,  that 
"medicines  differ  according  to  the  nature  of  the  climate;  one  kind 
being  necessary  in  Rome,  another  in  Egypt,  and  a  third  in  France." 
To  the  same  effect  Baglivi  says  that,  "  The  Spaniards,  any  more  than  the 
Italians,  if  their  physicians  may  be  credited,  cannot  well  bear  rough 
medicines  of  any  kind."  By  some  it  has  been  supposed  that  in  hot 
climates,  and  in  warm  weather,  venesection  was  a  remedy  which  ought 

*  Though  this  opinion  was  formerly  almost  universal,  I  doubt  its  correctness. — C. 
E.G. 


INTRODUCTION.  27 

not  to  be  resorted  to  for  fear  of  the  debility  which  it  might  induce. 
Erroneous  as  this  opinion  certainly  is,  tlierc  can  be  no  doubt  that 
under  certain  conditions  of  season  and  climate,  this  evacuation  cat  be 
better  sustained  by  the  constitution  than  it  can  under  others.  As  a 
general  rule  it  is  more  indicated  and  better  borne  during  the  winter 
and  spring  than  it  is  at  other  seasons.  In  dry  weather,  too,  it  is  bettor 
supported  than  it  is  in  moist  weather.  Yet,  as  a  general  fact,  the 
natives  of  moist  and  foggy  England  bear  bleeding  better  than  Ameri- 
cans ;  it  depends  probably  on  their  mode  of  life. 

Hillary   remarks,  that  in   Barbadoes,  under  equal   circumstances   of 
pain,  inflammation,  and  other  symptoms,  he   always  found  the   blood 
much  less  sizy  and  buffy  than  it  was  in   England,  and   a  consequent 
modification  of  the  treatment  was  called  for. 
Mr.  Boyle  says  the  same  of  the  coast  of  Africa. 

During  the  prevalence  of  the  sirocco,  it  has  been  observed  in  Egypt, 
as  well  as  in  Italy,  that  owing  to  the  depression  occasioned  by  it,  seda- 
tives cannot  in  any  case  be  with  safety  administered. 

The  effects  of  mercury,  too,  are  modified  very  greatly  by  the  nature 
of  the  season  and  the  climate.  In  hot  climates  it  is  much  more  diffi- 
cult to  bring  the  patient  under  the  influence  of  this  remedy,  than  in 
more  temperate  regions.  On  this  account  it  is,  that  such  large  quan- 
tities are  required  and  used  in  tropical  regions.  Independentlv,  how- 
ever, of  mere  temperature,  certain  regions  seem  to  be  adverse  to  the 
kindly  operation  of  this  metal  on  the  human  system.  In  Egypt,  accord- 
ing to  Baron  Larrey,  the  use  of  mercury,  even  in  venereal  disease, 
requires  the  greatest  caution.  If  used  with  the  same  freedom  as  in 
Europe,  it  produces  hepatic  and  various  other  affections. 

5.  Habit. — This  greatly  modifies  the  effects  of  many  medicinal 
agents ;  but  its  influence  is  not  the  same  in  all  cases  :  it  diminishes  the 

susceptibility  of  the  system  to  the  impression  of  some  medicines it 

greatly  increases  it  to  that  of  others.  Opium  furnishes  a  strikino-  illus- 
tration of  the  first  of  these.  The  quantity  of  this  drug  that  can  event- 
ually be  borne,  after  the  system  has  been  habituated  to  it,  is  reallv 
astonishing.  The  Malays  will  swallow  from  20  to  30  grains,  dailv,  with 
perfect  impunity;  and  in  civilized  society,  persons  have  been  known  to 
take  almost  any  quantity  without  suffering  any  inconvenience..  Mer- 
cury, on  the  other  hand,  observes  a  different  law,  and  the  system,  so  far 
from  becoming  habituated  to  its  use,  becomes  more  and  more  sensible 
to  its  operation.  When  a  person,  for  instance,  has  been  salivated 
several  times,  the  smallest  quantities  of  mercury  will  sometimes  produce 
the  most  violent  effects. 

6.  The  actual  condition  of  the  Systjmjit  the  time oj 'Jjtkin^Jhe  Medi- 
cine, with  regard  to  health  and  disease. — Of  all  the  circumstances  which 
modify  the  effect  of  remedies,  this  is  the  most  striking  and  important. 

3 


28  MATERIA    MEDICA    AND   THERAPEUTICS. 

Medicines  do  not  always  produce  the  same  effects  in  a  state  of  disease 
Avhich  they  do  in  perfect  health.  In  different  diseases,  too,  the  effects 
of  the  same  remedy  differ  entirely — almost  every  remedy  and  every 
disease  furnishes  an  illustration  of  these  facts.  In  apoplexy,  for  instance, 
the  most  active  emetics  fail  to  produce  their  ordinary  effect.  In  cer- 
tain diseased  states  of  the  intestinal  canal,  and  of  the  system,  the  most 
drastic  cathartics  can  be  made  to  produce  little  or  no  effect.  In  deli- 
rium tremens,  quantities  of  opium  have  been  given  with  very  little  effect, 
which,  in  the  ordinary  conditions  of  the  system,  would  inevitably  have 
been  followed  by  apoplexy  and  death.  In  tetanic  and  neuralgic  affec- 
tions, unaccompanied  by  inflammation,  narcotics  may  be  given  to  the 
greatest  extent  without  producing  any  of  their  ordinary  effects.  In 
congestion  of  the  brain,  and  inflammation  of  serous  membranes,  im- 
mense quantities  of  blood  can  be  taken  without  producing  syncope? 
■while  in  other  diseases,  particularly  of  an  irritative  character,  the  system 
succumbs  immediately  to  the  loss  of  the  vital  fluid. 

I  have  thus,  in  a  general  way,  noticed  some  of  the  circumstances 
modifying  the  effects  of  medicinal  agents.  When  I  come  to  treat  of 
them  in  detail,  all  these  circumstances  will  necessarily  come  again  under 
review,  for  more  special  and  particular  consideration. 

Of  the  Classification  of  Medicinal  Agents. — In  every  department  of 
knowledge,  a  general  classification  of  the  various  subjects  embraced  in 
it  is  of  the  greatest  utility.  It  simplifies  the  science,  and  thus  facilitates 
the  acquisition  of  it.  It  is,  in  fact,  nothing  more  than  a  generalization 
of  otherwise  individual  and  detached  facts,  by  some  principle  of  com- 
mon relation.  Any  principle  may  be  adopted  as  the  basis  of  a  classifi- 
cation, and  almost  every  classification  will  be  found  to  give  rise  to  new 
combinations  and  interesting  analogies.  It  is  not  to  be  inferred,  how- 
ever, that  it  is  a  matter  of  indifference  what  classification  is  adopted; 
on  the  contrary,  not  a  little  of  the  interest,  as  well  as  character  of  the 
science,  may  depend  upon  the  selection  which  may  be  made.  The 
principles  which,  it  appears  to  me,  ought  to  be  chiefly  held  in  view  in 
the  construction  of  a  classification  of  the  Materia  Medica,  are  the  follow- 
ing : — In  the  first  place,  the  basis  of  it  should  not  be  theories,  but  well 
established  facts.  Unless  it  be  so,  it  is  evident  that  the  classification 
must  be  fluctuating  in  its  character,  at  the  same  time  that  it  may  lead 
to  serious  practical  errors.  In  the  second  place,  as  the  great  object  of 
this  science  is  the  investigation  of  the  effects  of  medicinal  substances 
upon  the  human  system  with  a  view  to  the  cure  of  disease,  such  a  clas- 
sification should  be  preferred  as  is  best  suited  to  the  attainment  of  this 

object. 

By  keeping  these  principles  in  mind  we  shall  be  able  to  form  a  pretty 

correct  estimate  of  the  value  of  the    classifications  which   at  various 

periods  have  been  offered. 


INTUODUCTION.  29 

Among  the  earliest  attempts  at  arranging  tbe  articles  of  the  Materia 
Medica  was  that  of  classifying  them  according  to  their  sensible  proper- 
ties, sucli  as  color,  smell,  taste,  &c.  Such  a  classification  baa  the  advan- 
tage of  being  founded  on  plain  and  obvious  properties  appertaining  to 

medicinal  substances,  and  this,  so  far  as  it,  goes,  is  much  in  its  favor.  It 
presents  also  a  very  interesting  view  of  the  analogies  of  these  substanct 
so  far  as  their  sensible  properties  are  concerned.  And  if  these  proper- 
ties furnished  any  true  index  of  their  medicinal  effects,  the  classification 
would  be  unexceptionable.  Such,  however,  is  not  the  case,  and  it  fails, 
therefore,  in  the  principal  object  for  which  an  artificial  arrangement  may 
be  useful. 

The  next  attempt  was  founded  on  the  botanical  relations  between 
plants.  This  of  course  can  only  apply  to  vegetable  medicines,  and  on 
that  account  is  defective  as  the  basis  of  a  classification  which  ought  to 
embrace  all  medicinal  agents,  whether  animal,  mineral,  or  vegetable. 
So  far,  however,  as  it  can  be  applied  it  has  been  attempted  by  Murray 
and  De  Candolle,*  It  is  liable,  however,  to  the  same  objection  with 
that  founded  on  the  sensible  qualities  of  substances,  inasmuch  as  the 
natural  affinities  lead  to  no  certain  conclusions  in  relation  to  the  medi- 
cinal properties  of  plants. 

By  some  the  chemical  properties  of  substances  have  been  adopted  as 
the  basis  of  classification.  This  is  evidently,  however,  the  very  worst 
that  could  be  chosen,  both  for  the  uncertainty  and  imperfections,  even 
at  the  present  da}7,  of  the  analysis  of  vegetable  substances,  and  from  its 
leading  to  no  certain  conclusions  concerning  the  effects  of  medicines 
npon  the  living  system. 

The  last  principle  adopted  as  the  basis  of  a  classification  is  that  of 
the  medicinal  properties,  or,  in  other  words,  of  the  effects  which  they 
produce  upon  the  living  system.  Of  all  the  systems,  this  embraces  the 
greatest  number  of  advantages,  and  is  the  most  decidedly  practical  and 
useful  in  its  applications.  Like  the  others,  however,  it  is  very  far  from 
being  perfect.  This  arises  from  the  limited  extent  of  our  knowledge  in 
relation  to  the  animal  economy,  as  well  as  the  effects  of  medicinal  sub- 
stances upon  the  system.  It  is  in  consequence  of  this  that  so  many 
different  classifications  have  been  proposed,  all  based  upon  the  same 
common  principle,  but  varying  in  the  application  of  that  principle 
according  to  the  particular  views  which  may  be  entertained  in  relation 
to  the  laws  of  the  animal  economy  and  the  action  of  remedies.  All 
this  will  be  found  abundantly  illustrated  by  an  analysis  of  the  classifi- 
cations of  Cullen,  Murray,  Young,  and  indeed  every  other  modern  writer 


*  Essai  sur  les  proprietes  medicates  des  plantes,  comparees  avee  leurs  formes 
exterieures  et  leur  classification  naturelle.  Par  M.  Aug.  Pyr.  de  Candolle,  Prof. 
&c.     Seconde  edition.     Paris.     1816. 


30  MATERIA    MEDICA   AND    THERAPEUTICS. 

on  the  subject  of  the  Materia  Medica.     In  their  details,  however,  all 
these  classifications  are  liable  to  objection. 

By  some,  medicines  have  been  classified  according  to  the  particular 
part  or  tissue  of  the  system  upon  which  they  are  supposed  to  exert  a 
special  influence.  This  is  the  basis  upon  which  the  classifications  of 
Alibert  and  Eberle  are  founded.  Specious  as  this  is,  it  is'  nevertheless 
obnoxious  to  an  objection  which  is  insuperable.  "With  the  exception  of 
those  agents  which  are  purely  local  in  their  operation,  there  is  no 
medicine  which  is  limited  in  its  effects  to  any  particular  part  of  the 
body.  Directly  or  indirectly,  it  extends  its  action  more  or  less  to  other 
portions  of  the  system.  In  applying  it,  therefore,  to  individual  articles 
the  principle  of  the  classification  is  constantly  violated.  For  example, 
opium,  in  a  classification  of  this  kind,  is  placed  under  the  head  of  those 
agents  which  exert  their  influence  on  the  nervous  system  •  and  so  it 
does — but  besides  this  it  also  exerts  an  influence  on  the  vascular  system, 
on  the  skin,  on  the  liver,  on  the  urinary  organs,  and  thus  the  very  prin- 
ciple of  the  classification  is  contradicted.  So  also  with  almost  every 
other  agent.  This,  therefore,  can  never  furnish  a  solid  foundation  for  a 
classification. 

From  what  has  been  said,  it  must  be  obvious  how  impossible  it  must 
be  to  frame  a  classification  that  shall  be  unexceptionable.  In  the  one 
which  I  propose  as  the  basis  for  the  present  course  of  lectures,  my  only 
objects  will  be  simplicity  and  convenience,  and  I  shall  arrange  medi- 
cines according  to  their  more  prominent  and  acknowledged  effects  on 
the  system,  first  into  Six  Great  Classes. 


1.  Evacuants.  3.  Narcotics.  5.  Revulsives. 

2.  Depressants.  4.  Excitants.  6.  Alteratives. 

The  first  class  I  subdivide  into  nine  orders,  as — 1st.  Emetics,  2d.  Ca- 
thartics, 3d.  Anthelmintics,  4th.  Sialogogues,  5th.  Diaphoretics,  6th. 
Diuretics,  7th.  Expectorants,  8th.  Emmenagogues,  9th.  Parturients. 

Of  Depressants,  I  make  three  orders,  viz. — 1.  Sedatives,  2.  Refrige- 
eants,  3.  Demulcents. 

Narcotics  I  do  not  divide. 

Of  Excitants  there  are  four  orders, — 1.  Stimulants,  2.  Antispasmodics, 
3.  Tonics,  4  Astringents. 

Of  Revulsives  two,  Internal  and  External. 

Of  Alteratives  two,  Vital  and  Chemical. 


INTRODUCTION.  31 

ON   THE    COMMNATION    OF   MEDICINES. 

(Condensed  and  Abridged  from  Barbier.) 

Of  the  Combination  of  Emetics  with  other  Medicines. — For  very 
obvious  reasons  the  combination  of  emetic  medicines  with  those  of  other 
classes  must  be  exceedingly  limited.  They  would,  as  a  matter  of  course, 
be  ejected  before  they  could  produce  any  decided  effect.  Some  com- 
binations, however,  of  importance  are  in  use.  There  are  only  three 
cases  in  which  emetic  medicines  may  be  combined  with  other  medicinal 
agents,  viz. :  — 

1.  When  the  emetic  medicine  enters  into  the  composition  in  so  small 
a  quantity  that  it  cannot  excite  vomiting. 

2.  When  the  matters  associated  with  the  emetic  are  only  auxiliary  to 
its  operation  as  an  emetic. 

3.  When  by  the  union  of  different  ingredients  the  emetic  is  decom- 
posed and  loses  its  property. 

Combination  of  Emetics  with  Tonics. — These  generally  do  not  admit 
of  combination.  Tartar  emetic,  especially,  is  decomposed  by  most  of 
the  vegetable  tonics  and  astringents,  and  therefore  if  united,  the  emetic 
property  is  destroyed.  This  is  the  case  with  cinchona,  nut  galls, 
columbo,  «fcc.  Hence  vomiting,  too,  by  tartar  emetic  may  be  arrested 
by  the  administration  of  a  decoction  of  Peruvian  bark. 

Emetics  and  Stimulants. — Combinations  of  these  are  not  uncommon 
in  pharmacy.  The  wine  and  tinct.  of  ipecac  are  instances.  So  also  if 
tartar  emetic  be  dissolved  in  alcohol.  In  all  these  the  effects  of  the 
emetic  and  stimulant  are  observed.  In  analysing  the  effects  of  these 
compounds,  we  shall  find  that  the  stimulant  property  shows  itself  first; 
that  it  exalts  the  sensibility  of  the  digestive  passages,  and  thus  gives 
more  scope  to  the  subsequent  impression  of  the  emetic  ingredient.  This 
combination  is  useful  in  cases  of  poisoning  by  opium,  or  where  the 
stomach  is  rendered  torpid  by  the  poisou.  Here  antimony  acts  much 
more  powerfully  and  promptly,  if  given  in  alcoholic  solution.  This 
combination  is  also  useful  iu  cases  of  coma,  &c,  where  you  wish  to 
vomit  the  patient,  and  the  stomach  is  torpid. 

Emetics  and  Demulcents. — If  tartar  emetic  or  ipecac  be  mixed  with 
gum  arabic,  or  any  other  gummy  or  oleaginous  matter,  the  effect  is  to 
diminish  the  force  of  their  impression.  The  mucilaginous  matter  also 
relaxes  the  tissue  of  the  digestive  organs,  and  renders  them  less  sensible 
to  irritation  from  substances  in  the  alimentary  passages. 

Emetics  and  Refrigerants. — Here  two  things  are  to  be  considered  ; 
the  chemical  action  of  vegetable  acids  upon  the  emetic  substance,  and 
the  refrigerant  action  of  those  acids  upon    the  organs  where  emetics 


32  MATERIA   MEDICA   AND   THERAPEUTICS, 

exert  their  power.  Tartaric  and  citric  acids  decompose  tartar  emetic,, 
but  the  new  saline  substances  which  are  formed  remain  in  solution  in  the 
liquor,  and  equally  produce  vomiting.  One  may  add  to  an  emetic  water, 
syrup  of  lemons,  or  currants,  without  destroying  its  emetic  virtue..  If, 
during  the  action  of  an  emetic,  currant  water  or  lemonade  be  drunk,  it 
weakens  the  irritation  which  the  emetic  has  established  upon  the  gastric 
and  intestinal  surface. 

Emetics  and  Narcotics. — Emetic  medicines  are  frequently  combined 
with  opium,  as  Dover's  powder,  or  laudanum  in  a  solution  of  tartar 
emetic,  &c. ;  but  here  the  emetic  is  not  generally  in  sufficient  quantity 
to  vomit. 

Emetics  and  Purgatives. — This  is  a  very  common  and  useful  com- 
bination. One  or  two  grains  of  tartar  emetic  with  one  or  two  drachms 
of  sulphate  of  soda  or  sulphate  of  magnesia,  in  four  cups  of  water,  or 
ten  or  twelve  grains  of  ipecac  in  a  cup  of  infusion  of  senna,  &c.  These 
are  called  emetico-cathartics,  and  generally  operate  both  ways.  The 
effect  of  an  emetico-cathartic  is  always  mild,  as  it  usually  consists  only 
of  half  a  dose  of  emetic  and  half  a  dose  of  purgative.  Most  commonly 
it  causes  two  or  three  vomitings  and  two  or  three  stools.  The  irritation 
which  it  causes  in  the  alimentary  canal  is  always  mild,  moderate,  and 
transient.  This  combination  is  beneficial  when  you  wish  to  irritate 
mildly  the  digestive  passages,  and  to  obtain  at  once,  without  wearying 
the  patient,  evacuations  up  and  down.  They  are  not  to  be  used  where 
simple  vomiting  is  your  object,  as  in  cases  of  poisoning,  <fcc. 


PURGATIVES. 

Purgatives  with  Tonics. — If,  in  combining  these  together,  the  purga- 
tive is  in  sufficient  quantity  to  act  promptly  and  freely,  it  counteracts 
the  effect  of  the  tonic.  On  the  contrary,  if  it  be  added  only  in  small 
proportions,  the  tonic  may  produce  its  effect  independently  of  the 
moderate  purgation.  Many  celebrated  physicians  have  recommended 
the  combination  of  Rhubarb  with  the  Peruvian  bark. 

In  the  joint  operation  of  a  purgative  and  a  tonic  the  latter  increases 
astonishingly  the  energy  of  the  former.  On  this  account  it  is  recom- 
mended to  diminish  the  dose  of  the  cathartic  substance,  where  it  is 
united  with  a  tonic — as  this  last,  by  strengthening  the  tissue  of  the 
intestines,  by  developing  their  tonicity,  renders  them  more  sensible  to 
the  action  of  the  purgative.  This  is  verified  in  the  mixture  of  jalap, 
scammony,  &c,  with  gentian,  elecampane,  cinchona,  red  roses,  &c. 
The  same  thing  happens  when  the  leaves  of  senna  are  put  in  a  decoc- 
tion of  the  root  of  the  wild  dock,  of  the  dandelion,  the  wild  endive,  the 
fumitory,  &c.     The  quantity  of  the  syrup  of  buckthorn  which  is  neces- 


INTRODUCTION.  33 

sary  to  make  powder  of  cinchona  into  an  electuary,  is  sufficient  to  give 
it,  the  purgative  property  which  it  possesses;  and  the  lozenges,  in  which 
the  principles  of  bark  and  those  of  senna  and  rhubarb  are  united,  pro- 
duce usually  abundant  evacuations. 

Purgatives  with  Carminatives. — Excitants  increase  much  more  even 
than  tonics  the  activity  of  purgatives.  They  stimulate  the  tissue  of  the 
intestines  and  develope  the  vitality,  and  thus  the  purgative  principles 
cause  an  impression  more  deep  and  strong  upon  a  surface  more  sensi- 
ble and  irritable.  The  purge  acts  with  unaccustomed  celerity  ;  the  eva- 
cuations are  more  frequent,  and  necessarily  they  are  not  preceded  by  that 
nausea  which  accompanies  the  pure  purgations.  The  ancients  were  much 
in  the  habit  of  combining  them — such  as  anise  seed  with  decoction  of 
senna — powder  of  ginger  with  turpeth  mineral,  and  fennel  with  scam- 
mony,  &c. 

Purgatives  with  Diffusible  Stimulants. — The  wines,  tinctures,  and 
ethers  of  various  purgatives  are  illustrations.  In  using  these,  the  two 
properties  are  very  evident,  and  it  is  easy  to  perceive  that  their  operation  is 
not  simultaneous  but  developed  successively.  Thus  the  stomach  and 
intestinal  canal  are  first  excited,  and  some  time  after  this,  the  ordinary 
symptoms  of  purgation  show  themselves.  The  effect  of  the  compound 
differs  according  to  the  relative  proportions  of  the  ingredients.  If  the 
purgative  principle  be  small,  then  the  stimulant  effects  are  very  marked 
and  continue  long.  If  the  menstruum  be  small,  on  the  contrary,  then 
the  stimulant  effect  is  transitory  and  disappears  with  the  purging. 

Purgatives  with  Demulcents. — Emollients  relax  the  living  tissues, 
weaken  their  tonicity,  and,  therefore,  diminish  the  power  of  purgative 
agents.  Broths,  ptisans,  &c,  taken  before  or  during  the  operation  of  a 
purge,  have  the  effect  of  moderating  the  violence  of  its  operation. 
Manna,  cassia,  gummy  substances,  &c,  which  are  united  with  purga- 
tives before  they  are  administered,  serve  as  correctives  of  the  purgatives. 
These  additions  are  not  proper  when  the  object  is  only  to  cause  intesti- 
nal irritation  or  a  general  action  in  the  system. 

Purgatives  with  Acidulous  Substances. — The  action  of  Acids  tends 
always  to  repress  the  impression  of  the  purgative  substances  when  they 
become  too  strong  or  profound.  Lemon  juice  or  orange  juice  added  to 
a  decoction  of  senna  leaves,  or  to  that  of  rhubarb,  or  lemonade  or  cur- 
rant water  drunk  after  the  administration  of  the  purgative  medicines, 
always  fulfils  this  indication.  Tamarinds,  cream  of  tartar,  produce  no 
other  effect  when  added  to  jalap,  scammony,  efce.  It  is  easy  to  perceive 
that  by  moderating  the  too  great  irritation  which  purgatives  excite  in 
the  alimentary  canal,  acids  may  favor  intestinal  exhalation  and  secretion, 
and  thus  render  the  evacuations  more  free  and  abundant.  But  they 
are  not  proper  when  the  object  is  to  excite  a  considerable  irritation  in 
the  intestines — to  cause  revulsion  or  to  excite  the  whole  system. 


34  MATERIA  MEDICA  AND   THERAPEUTICS. 

Purgatives  with  Narcotics. — Opium  counteracts  purging.  It  may, 
therefore,  be  used  to  counteract  too  violent  purgation.  If  it  be  com- 
bined in  a  purgative,  the  dose  must  be  increased  to  produce  the  effect* 
Sydenham  used  to  give  a  small  quantity  of  opium  previous  to  a  purga- 
tive in  cases  where  the  sensibility  was  too  lively  or  where  he  feared  the 
purgative  might  produce  too  much  excitement.  Frequently  physicians 
give  at  night  an  opiate  to  those  who  are  to  be  purged  in  the  morning. 


NARCOTICS. 

Narcotics  with  Tonics. — The  effect  of  this  combination  differs  of 
course  according  to  the  relative  proportions  of  each  in  the  compound. 
If  the  quantity  of  narcotic  is  large,  then  the  compound  will  have  to  be 
given  in  such  small  doses  as  that  the  tonic  can  have  but  little  effect. 
If  the  opium  is  in  small  quantity  then  the  effects  of  both  tonic  and 
narcotic  are  produced.  The  Diascordium  is  an  example  of  this.  In 
3  ss.  of  this  electuary  there  is  not  more  than  -ith  of  a  gr.  of  opium,  the 
rest  being  composed  of  tonic  substances.  Hence  the  tonic  effect  pre- 
dominates. It  produces  a  tonic  and  calming  effect,  useful  in  affections 
of  the  bowels,  diarrhoea,  &c. 

When  the  great  susceptibility  of  the  stomach  or  intestines  does  not 
enable  them  to  bear  tonics,  opium  in  the  form  of  laudanum  may  be  add- 
ed to  moderate  this  susceptibility.  This  is  often  necessary  in  intermit- 
tent fever  to  enable  the  patient  to  retain  the  cinchona  either  in  electu- 
ary or  enema.  It  is  necessary,  however,  here  to  distinguish  between 
nervous  irritability  and  phlogosis  of  the  stomach. 

Narcotics  with  Stimulants. — Here,  too,  the  character  of  the  com- 
pound is  determined  by  the  relative  proportions^of  the  ingredients.  Those 
compounds  in  which  opium  predominates  can  be  given  only  in  small 
doses — such  is  the  condition  of  canella,  cloves,  &c,  in  the  wine  of  opium 
or  laudanum.  In  15  gtt.  or  more  of  this,  the  excitant  articles  do  not 
exhibit  any  of  their  peculiar  property. 

In  the  Isle  of  France,  the  old  gastronomes  take  after  every  repast  one 
or  two  large  pastilles  which  are  composed  of  opium  and  a  number  of 
stimulant  articles,  cloves,  mace,  nutmeg,  and  musk.  As  the  opium  is  in 
small  quantity  it  does  not  render  the  stomach  torpid — on  the  contrary 
the  combination  excites  its  action  and  promotes  digestion. 

Narcotics  with  Diffusible  Stimulants. — Wine,  alcohol,  and  ether  may  be 
united  with  opium  without  causing  any  chemical  change  in  either.  Here 
both  properties  are  preserved  and  their  effects  are  produced,  not  simul- 
taneously, but  successively — the  diffusible  first  and  then  the  opiate.  Po- 
tions in  which  ether  or  alcohol  is  added  to  laudanum,  or  other  opiates, 


INTRODUCTION.  35 

are  in  frequent  use.  Barbier  thinks  the  Nepenthe  of  Eomer  whs  a  com- 
bination of  this  kind,  opium  in  wine.     See  vol.  iii.  p.  6. 

Narcotics  with  Emollients. — Opiates  added  to  gruel,  marsh  mallows,  &C. 
&c.,  are  instances  of  this.  They  are  good  in  intestinal  irritation,  colics, 
diarrhoea,  &c.  This  combination  produces  another  effect.  The  debili- 
tating influence  of  the  compound  upon  the  gastric  organ  hinders  the 
chymification  of  the  mucilaginous  matters — prevents  their  absorption. 

Narcotics  with  Acids. — The  use  of  an  acid  favors  the  absorption  of 
the  opium  by  favoring  its  complete  solution  ;  but  when  the  system  is 
under  the  influence  of  opium,  the  acid  seems  to  moderate  its  effects. 

[These  aphorisms  from  Barbier  were,  I  believe,  used  by  Dr.  B.  as 
texts  for  extemporaneous  remarks.  They,  seem  to  me  to  contain  so 
much  practical  good  sense  that  I  retain  them. — Ed.] 


PEOXIMATE    PKINCIPLES. 


Before  entering  upon  the  consideration  of  particular  medicines  I  shall 
make  a  few  remarks  concerning  the  chemical  composition  of  organic 
substances.  Upon  this  department  an  immense  amount  of  learned  labor 
has  been  expended,  and  it  is  proper  that  you  should  be  acquainted  with 
the  results  of  it.  With  what  are  called  the  proximate  principles,  it  is 
especially  necessary  that  you  should  be  familiar,  inasmuch  as  a  know- 
ledge of  them  will  greatly  facilitate  your  inquiries  in  relation  to  the  pro- 
perties of  the  different  individual  articles  of  the  Materia  Medica  that  I 
may  have  occasion  to  notice.  An  account  of  them  enters  into  the  his- 
tory of  all  medicinal  plants,  and  their  investigation  serves  to  throw  much 
light,  not  merely  upon  their  chemical  and  pharmaceutical  relations,  but 
has,  in  many  instances,  proved  the  means  of  discovering  some  of  the 
most  active  medicinal  agents  at  present  in  our  possession.  I  must  con- 
tent myself,  however,  with  an  outline  of  this  subject,  referring  you  for 
details  to  the  various  chemical  works  which  have  been  recently  pub- 
lished. 

Organic  substances,  whether  derived  directly  from  the  vegetable  or 
animal  kingdom,  or  produced  by  the  various  processes  of  art,  are  re- 
markable for  their  great  complexity  of  constitution,  while  their  ultimate 
elements  are  comparatively  few  in  number.  Instead  of  the  sixty  or  more 
constituents  of  inorganic  compounds,  a  few  only,  as  oxygen,  hydrogen, 
carbon,  nitrogen,  and  occasionally  sulphur,  phosphorus,  and  two  or  three 
others,  enter  into  the  composition  of  vegetable  and  animal  products. 

The  combination  of  a  certain  number  of  these  few  elements,  under 
varying  conditions,  in  various  proportions,  gives  rise  to  a  great  variety  of 
products  which  are  called  proximate  principles.  Thus,  oxalic  acid  is  a 
proximate  principle  found  in  the  Oxalis  acetosella,  L.,  and  in  other 
plants ;  by  analysis  it  may  be  resolved  into  its  elements,  carbon  and 
oxygen.  Sugar  is  constituted  of  cai'bon,  hydrogen,  and  oxygen.  And 
morphine,  one  of  the  proximate  principles  of  opium,  consists  of  carbon, 
hydrogen,  oxygen,  and  nitrogen. 

I  have  already  stated  that,  notwithstanding  the  simplicity  of  compo- 
sition which  characterizes  organic  substances,  they  exhibit  much  greater 
complexity  than  the  products  of  the  mineral  kingdom.  In  the  latter,  the 
combination  can  generally  be  represented  by  what  may  be  termed  the 


PROXIMATK    I'lMM'irl.KS.  3V 

binary  arrangement.  Thus,  oxide  of  copper  is  composed  of  copper  and 
oxygon,  potash  of  potassium  and  oxygen,  sulphuric  acid  of  Bulphur  and 
oxygen;  while  sulphuric  acid  unites  both  with  oxide  of  copper  and  oxide 

of  potassium. 

But  the  products  of  organization  arc,  with  few  exceptions,  of  ;t  much 
more  complex  character.  Their  atoms  unite  in  groups,  namely,  2,  3,  1, 
6,  8,  10  or  more  atoms  of  one  element,  with  any  Dumber  of  atoms  of 
the  other  elements.  Thus,  an  atom  of  morphine  is  formed  of  thirty- 
four  atoms  of  carbon,  twenty  of  hydrogen,  six  of  oxygen,  and  one  of 
nitrogen.  Albumen  has  been  represented  by  the  formula  of  four  hun- 
dred atoms  of  carbon,  three  hundred  and  ten  of  hydrogen,  one  hundred 
and  twenty  of  oxygen,  fifty  of  nitrogen,  two  of  sulphur,  and  one  of 
phosphorus.  These  numerous  atoms  seem,  as  it  were,  to  be  bound  up 
into  a  single  whole,  which  can  enter  into  combination  with  other  sub- 
stances, and  be  thence  disengaged  with  properties  unaltered. 

Sometimes  also  the  slightest  changes  in  elementary  composition  give 
rise  to  new  and  different  proximate  principles.  Thus  succinic  acid> 
obtained  from  amber,  consists  of  four  atoms  of  carbon,  two  atoms  of 
hydrogen,  and  three  atoms  of  oxygen.  If  one  atom  of  oxygen  is  added 
to  this,  we  have  the  constitution  of  malic  acid.  If  one  more  atom  of 
oxygen  is  added,  that  of  tartaric  acid.  And  by  adding  yet  another 
atom  of  oxygen,  that  of formic  acid. 

Again,  cane  sugar  and  gum  arabic  have  precisely  the  same  constitu- 
tion, viz.  twelve  atoms  of  carbon,  eleven  of  hydrogen,  and  eleven  of 
oxygen,  so  starch  and  lignin  have  each  twelve  atoms  of  carbon,  and  ten 
each  of  hydrogen  and  oxygen  ;  they  are  isomeric  (from  the  Greek,  itfog, 
equal,  and  ixspocr,  a  part).  Cases  of  this  kind  are  very  common  among 
organic  substances,  and  they  seem  usually  to  depend  upon  peculiarities 
of  atomic  arrangement. 

From  these  peculiarities  in  the  constitution  of  organic  bodies,  they 
have  a  very  unstable  character — are  very  liable  to  spontaneous  decom- 
position— are  decomposed  by  a  red  heat,  and  nearly  all  of  them  are 
partially  changed  by  a  temperature  far  below  ignition. 

The  proximate  analysis  of  organic  bodies  varies  considerably  with 
the  nature  of  the  substance  to  be  separated,  and  some  of  these  will  be 
hereafter  noticed.  The  ultimate  or  elementary  analysis  consists  in  the 
decomposition  of  the  body  by  heat,  in  contact  with  some  other  sub- 
stance. The  mode  now  generally  adopted  is  to  burn  the  matter  to  be 
analysed  by  means  of  oxide  of  copper  (obtained  by  the  decomposition 
of  the  nitrate  of  copper),  so  as  to  convert  its  carbon  into  carbonic  acid, 
and  its  hydrogen  into  water,  both  of  which  are  collected  and  weighed, 
and  the  proportion  of  each  of  the  above  elements  atomically  determined, 
the  oxygen  being  estimated  by  difference.  "When  the  matter  contains 
nitrogen,  it  is  collected  in  the    form  of   gas,  or  it  is   converted    into 


38  MATERIA  MEDIC  A   AND  THERAPEUTICS. 

ammonia,  by  mingling  the  substance  with  a  mixture  of  hydrate  of  lime 
and  caustic  soda,  and  subjecting  the  whole  to  a  red  heat.  There  are, 
however,  several  precautions  necessary  to  the  success  of  these  processes, 
for- an  account  of  which  I  must  refer  you  to  standard  chemical  works. 

Although  most  of  the  proximate  principles  employed  in  the  Materia 
Medica  are  derived  from  the  vegetable  kingdom,  a  few  of  those  obtained 
from  animal  products  have  been  recently  introduced.  I  shall  briefly 
notice  some  of  the  more  important  proximate  principles. 

The  following  will,  I  think,  be  found  to  be  a  convenient  classification 
of  these  proximate  principles. 

I.  Organic  acids  and  their  compounds,  with  bases. 
II.  Organic  alkalies  and  the  substances  allied  to  them. 

III.  Oleaginous,  resinous,  and  bituminous  principles. 

IV.  Alcoholic  and  ethereal  principles. 
V.  Sugars  and  their  congeners. 


I. ORGANIC    ACIDS. 

These  acids  are  characterized  by  having,  with  an  exception  or  two,  a 
sour  taste,  changing  the  blue  of  litmus,  but  more  especially  by  their 
power  of  combining  with  salifiable  bases.  Like  all  organic  principles, 
they  are  decomposed  by  a  red  heat ;  though  they  are  in  general  less 
liable  to  spontaneous  decomposition  than  most  other  organic  products. 

Some  of  the  organic  acids  are  the  products  of  nature  alone ;  some 
are  the  production  of  nature  and  of  art ;  and  some  are  exclusively  the 
products  of  art. 

Among  the  more  important  of  these  bodies  are  the  following. 

Acetic  Acid. — This  acid  exists  in  the  sap  of  almost  all  plants,  either 
free  or  combined  with  potassa  or  lime,  and  is  also  abundantly  the  pro- 
duct of  art.  In  a  concentrated  form,  it  is  most  advantageously  prepared 
by  the  decomposition  of  the  acetate  of  soda  by  sulphuric  acid  and  sub- 
sequent distillation.  It  may  also  be  obtained  by  the  distillation  of 
common  vinegar,  which  is  prepared  by  exposing  malt  or  vinous  liquors 
to  the  free  access  of  atmospheric  air,  at  a  temperature  slightly  elevated. 
When  this  acid  is  combined  with  bases  it  forms  a  class  of.  salts  called 
Acetates. 

What  is  termed  Pyroligneous  acid,  is  an  impure  acetic  acid  prepared 
by  the  distillation  of  wood.  When  first  made,  it  is  of  a  dark  color, 
holding  in  solution  a  portion  of  tar  and  volatile  oil,  from  which,  how- 
ever, it  may  be  freed  by  subsequent  processes. 

When  metallic  acetates  in  an  anhydrous  state  are  subjected  to  de- 
structive distillation,  they  yield,  among  other  products,  an  inflammable 
volatile  substance  called  Acetone  or  Pyro-acetic  Spirit.     When  pure,  it 


PROXIMATE  PEINOIPLES.  39 

is  a  colorless,  limpid  liquid,  having  an  empyreumatic  odor  and  a  dis- 
agreeable taste.     It  burns  with  a  bright  flame,  and  mixes  in  all  propor 
tions  with  water,  alcohol,  and  ether.     By  the  action  of  acids  it  under- 
goes a  variety  of  changes. 

Benzoic  Acid. — This  is  the  Flowers  of  Benzoin  of  the  shops,  a  name 
which  it  has  received  from  having  been  originally  obtained  from  the 
Gum  Benzoin,  the  produce  of  the  Styrax  benzoin  (Dryand.).  It  exists 
also  in  the  Balsams  of  Peru  and  Tolu,  and  several  aromatic  plants.  It 
may  be  obtained  in  a  state  of  purity  by  gently  heating  gum  benzoin  in 
a  shallow  iron  vessel  with  a  cone  of  paper  placed  over  a  paper  diaphragm 
pierced  with  pinholes  (Mohr's  subliming  apparatus).  It  occurs  in  white 
acicular  crystals  of  a  satiny  appearance;  has  an  aromatic  rather  than  a 
sour  taste,  though  it  reddens  litmus.  It  combines  with  bases  and  forms 
a  class  of  salts  called  JBenzoates. 

Citric  Acid. — This  acid  exists  in  great  quantity  in  the  juice  of  limes 
and  lemons;  it  is  found  in  many  other  fruits,  as  in  gooseberries,  cur- 
rants, &c,  in  conjunction  with  another  acid,  the  malic.  It  exists,  when 
pure,  in  the  form  of  large  transparent  crystals,  which  have  an  agreeable 
acid  taste.  It  reddens  litmus  powerfully,  is  freely  soluble  in  both  hot 
and  cold  water,  and  combines  with  bases  forming  a  class  of  salts  called 
Citrates. 

Gallic  Acid. — This  acid  is  formed  from  tannin  by  a  kind  of  fermen- 
tation. It  is  obtained  from  the  gall  nut.  "When  pure,  it  is  in  the  form 
of  small,  feathery,  and  nearly  colorless  crystals,  which  have  a  fine  silky 
lustre.  Its  taste  is  slightly  acid  and  styptic;  it  is  soluble  in  100  parts 
of  cold,  and  in  three  parts  of  boiling  water.  Gallic  acid  does  not  preci- 
pitate gelatin,  by  which  it  is  distinguished  from  tannic  acid,  with  which 
it  is  often  associated.  With  a  proto-salt  of  iron  no  change  is  produced, 
but  with  a  per-salt  a  deep  bluish  black  precipitate  falls,  which  disappears 
when  the  liquid  is  heated,  from  the  reduction  of  the  peroxide  of  iron  to 
the  protoxide  at  the  expense  of  the  gallic  acid.  With  bases  this  acid 
forms  Gallates. 

Lactic  Acid. — This  is  the  result  of  the  fermentation  of  milk.  It  may 
also  be  extracted  from  great  varieties  of  liquids  containing  decomposing 
organic  matter,  as  sauer  kraut,  a  preparation  of  white  cabbao-e,  the  sour 
liquor  of  the  starch-maker,  &c.  In  the  purest  form  in  which  it  can  be 
obtained,  it  is  a  syrupy,  colorless  liquid,  having  an  intensely  sour  taste 
and  acid  reaction.     With  bases  it  forms  Lactates. 

Meconic  Acid. — This  acid  is  found  in  opium,  and  when  pure,  crystal- 


40  MATERIA   MEDICA   AND   THERAPEUTICS. 

lizes  in  small,  colorless,  pearly  scales,  which  are  soluble  in  four  parts  of 
boiling  water,  and  also  in  alcohol.  It  has  an  acid  taste  and  reaction, 
and  with  bases  forms  Meconates.  The  most  remarkable  feature  of  this 
substance  is  its  property  of  striking  a  deep  blood-red  color  with  a  salt 
of  the  peroxide  of  iron. 

Oxalic  Acid. — This  acid  occurs  in  the  juice  of  several  plants,  espe- 
cially in  that  of  the  Rumex  acetosa,  L.,  or  common  sorrel,  the  Oxalis 
acetosella,  Z.,  or  wood  sorrel,  and  in  the  varieties  of  Rhubarb.  It  is 
usually  in  combination  with  potash  as  an  acid  salt  or  with  lime.  It  is 
also  the  produce  of  art,  and  is  now  manufactured  in  large  quantities  by 
the  action  of  nitric  acid  on  sugar,  starch,  and  dextrine.  It  crystallizes 
in  slender,  colorless,  transparent  crsytals,  which  dissolve  in  eight  parts 
of  water  at  60°,  and  in  their  own  weight  or  less  of  hot  water.  The 
aqueous  solution  has  an  intensely  sour  taste,  a  powerful  acid  reaction, 
and  is  highly  poisonous.  Oxalic  acid,  when  heated  with  sulphuric, 
yields  carbonic  oxide  and  carbonic  acid.     With  bases  it  forms  Oxalates. 

Prussic  Acid. — This  acid,  also  known  by  the  name  of  hydrocyanic 
acid,  is  remarkable  for  its  poisonous  properties.  It  exists  in  the  bitter 
almond,  the  kernels  of  plums  and  peaches,  the  leaves  of  the  cherry- 
laurel,  and  in  several  other  plants.  It  is  also  largely  obtained  by  pro- 
cesses of  art  from  various  animal  matters.  When  obtained  pure  by  the 
decomposition  of  the  cyanide  of  mercury,  it  is  a  thin,  colorless,  and 
exceedingly  volatile  liquid,  with  a  powerful  odor,  resembling  that  of 
peach  blossoms,  or  bitter  almond  oil ;  it  has  a  feeble  acid  reaction,  and 
mixes  with  water  and  alcohol  in  all  proportions.  In  its  anhydrous  form, 
it  is  one  of  the  most  deadly  poisons  known,  and  even  when  largely 
diluted  with  water,  its  effects  upon  the  animal  system  are  very  energetic. 
It  combines  with  bases,  forming  salts  which  are  called  prussiates,  or 
hgdrocyanates.  [The  researches  of  Liebig,  Wohler,  &c,  haye  proved 
that  hydrocyanic  acid  does  not  exist  ready  formed  in  bitter  almonds, 
but  is  formed  by  the  action  of  synaptase  on  amygdalin.  The  presence 
of  water  is  essential  to  this  action.  The  same  is  probably  true  of  many 
other  vegetables  from  which  the  acid  is  obtained.] 

Tannic  Acid. — This  acid,  sometimes  known  by  the  name  of  tannin, 
exists  in  the  bark  of  various  species  of  quercus,  and  many  other  trees ; 
and  in  gall  nuts,  from  which  it  is  procured  in  the  greatest  quantity. 
In  the  purest  form  in  which  it  can  be  obtained,  it  occurs  as  a  slightly 
yellowish,  friable,7  porous  mass,  without  any  tendency  to  crystallization. 
It  is  very  soluble  in  water,  less  so  in  alcohol,  and  very  slightly  in  ether. 
It  reddens  litmus,  has  a  pure  astringent  taste,  without  any  bitterness, 
and  with  bases  forms  tannates. 


PROXIMATE   PBINOIPLES.  41 

Tannic  acid  is  often  associated  with,  and  mistaken  for,  gallic  ■"  id. 
The  proto-salts  of  iron  are  not  altered  by  tannic  acid,  but  in  the  pcr- 

salts  it  occasions  a  dark  blue  precipitate;  it  is  the  basis  of  writing 
ink.  It  also  precipitates  animal  gelatin,  forming  a  yellowish,  viscid, 
elastic  mass,  called  tannogelatin,  which  is  the  essential  basis  of  Leather, 

Tartaric  Acid. — This  is  the  acid  of  grapes,  of  tamarinds,  and 
several  other  fruits,  being  found  in  them  sometimes  free,  but  generally 
in  combination  with  lime  or  potash.  The  tartaric  acid  of  commerce  is 
wholly  prepared  from  the  tartar  or  argol,  an  impure  acid  tartrate  of 
potash,  deposited  from  gr%pe  juice,  in  the  act  of  fermentation.  When 
pure,  it  occurs  in  transparent,  often  highly  modified  crystals,  the  primary 
form  of  which  is  a  rhombic  prism.  It  has  a  very  sour  taste,  and  red- 
dens litmus  powerfully;  is  soluble  in  both  cold  and  hot  water,  and 
slightly  so  in  alcohol.  The  crystals  undergo  no  change  by  exposure  to 
the  air,  but  its  aqueous  solution  soon  becomes  covered  with  mould.  It 
is  a  cheap  substitute  for  citric  acid  in  lemonade  and  effervescent 
solutions.  With  bases,  it  forms  an  important  class  of  salts,  called 
tartrates. 

Valerianic  Acid. — This  acid  exists  in  a  variety  of  products,  but  has 
usually  been  obtained  by  the  oxidation  of  an  oil  procured  by  distilling 
the  root  of  the  common  valerian,  Valeriana  officinalis,  L.,  or  by  drop- 
ping the  volatile  oil  of  potato-brandy  (fusel  oil),  slightly  warmed,  upon 
platinum  black.  In  this  case,  the  acid  bears  the  same  relation  to  the 
fusel  oil,  as  acetic  acid  does  to  alcohol,  or  formic  acid  to  wood  spirit. 
It  is  a  colorless,  oily  liquid,  with  the  odor  of  valerian,  and  a  sour,  pun- 
gent, and  nauseous  taste.  It  dissolves  in  all  proportions  in  alcohol  and 
ether,  and  forms  with  bases  a  well  characterized  class  of  salts,  called 
valerianates. 


ii. — organic  alkalies,  and  the  allied  substances. 

Under  this  head  are  classed  all  those  proximate  principles  which  are 
capable  of  uniting  with  acids,  and  of  forming  with  them  saline  com- 
pounds. The  existence  of  this  class  of  bodies  wras  discovered  in  1803, 
by  Sertuerner,  a  German  apothecary ;  but  they  excited  no  attention 
until  about  the  year  1816,  when  he  ascertained  their  true  nature. 
Since  that  time,  this  department  has  been  cultivated  by  several  chemists, 
but  especially  by  Robiquet,  Pelletier,  and  Caventou. 

The  organic  alkalies  consist  of  carbon,  hydrogen,  oxygen,  and  nitro- 
gen. They  are  for  the  most  part  solid,  of  a  white  color,  and  mostly 
crystalline  when  in  a  state  of  purity,  usually  inodorous,  but  having  a 


42  MATERIA  MEDICA  AND  THERAPEUTICS. 

bitter  or  acrid  taste.  They  are  not  affected  by  exposure  to  air  or  light, 
but  are  in  most  instances  decomposed  by  a  moderate  heat.  They 
change  vegetable  blues  to  green.  In  water,  they  are  nearly  insoluble ; 
in  cold  alcohol,  sparingly  soluble;  but  in  boiling  alcohol,  readily  so. 
From  the  hot  alcoholic  solution  they  are  deposited,  on  cooling,  generally 
in  the  crystalline  form. 

These  substances  are  never  found  in  nature  in  a  free  state,  but  appear 
in  every  case  to  be  combined  with  an  acid,  forming  a  salt  more  or  less 
soluble  in  water.  The  process  for  separating  them,  which  is  generally 
applicable,  is  to  digest  or  macerate  the  substance  containing  the  alkali 
in  water,  acidulated  with  muriatic  acid,  and  to  add  to  the  filtered  solu- 
tion a  more  powerful  salifiable  base,  as  ammonia,  lime,  or  magnesia. 
The  organic  alkali  is  thus  separated  from  the  acid,  and,  being  insoluble 
in  water,  is  precipitated.  This  precipitate,  mixed  with  some  animal 
charcoal,  is  then  dissolved  in  boiling  alcohol,  and  the  solution  filtered 
while  hot  and  evaporated.  The  pure  alkali  is  thus  usually  obtained, 
but  sometimes  the  latter  part  of  the  process  requires  to  be  repeated. 

I  shall  very  briefly  notice  a  few  of  the  more  important  organic 
alkalies. 

Morphine. — This  is  one  of  the  alkalies  found  in  opium.  When 
crystallized  from  alcohol,  it  forms  small  but  very  brilliant  prismatic 
crystals,  which  are  transparent  and  colorless.  Although  it  has  a  bitter 
taste,  it  is  almost  insoluble  in  cold  water.  It  forms  salts  with  acids, 
which  are  mostly  soluble  and  crystallizable.  This  alkali,  in  powder, 
strikes  a  deep  bluish  color  with  neutral  persalts  of  iron. 

Narcotine  is  another  alkali  found  in  opium,  and  often  associated 
with  morphine.  When  pure,  it  is  in  the  form  of  colorless  prisms, 
which  are  tasteless  and  almost  insoluble  in  water.  It  is  distinguished 
from  morphine  by  its  solubility  in  ether. 

Codeine,  Thebaine,  Narceine,  Pseudomorphine,  and  Meconine, 
are  the  names  given  to  other  alkaline  principles  extracted  from  the 
very  complex  substance,  opium. 

Quinine. — This  is  the  alkali  of  the  Peruvian  bark,  in  which  it  is 
associated  with  the  kinic  acid.  It  is  in  the  form  of  white  needle-form 
crystals,  which  have  an  intensely  bitter  taste,  and  are  soluble  in  about 
200"  parts  of  boiling  water.  With  acids  it  forms  salts,  which  are 
generally  crystallizable.  The  subsulphate  of  quinine  is  manufactured  on 
a  large  scale  for  medicinal  use. 

Cinchonine  exists  in  large  quantity  in   the   Cinchona   condaminea, 


1'ItOXIMATK    I'KJNCII'I.KS.  43 

Ilumb.,  or  pale  bark,  and  is  associated  wi.t.li  quinine  in  all  the  Bpeci<  oi 
the  Peruvian  barks.  When  pure,  it  crystallizes  in  small  bat  brilliant 
prisms.  It  is  but  very  feebly  soluble  in  water,  dissolves  readily  in  boil- 
ing alcohol,  and  lias  but  little  taste.  It  unites  with  all  acids,  and  forms 
a  series  of  crystal] izable  salts. 

When  both  the  above  bases  arc  present  in  a  sample  of  bark,  they 
may  be  separated  by  converting  them  into  sulphates.  The  salt  of 
quinine  is  the  least  soluble  of  the  two,  and  crystallizes  first. 

Quinoidine  or  Chinoidine,  a  substance  obtained  from  the  mother- 
liquor  in  the  process  for  procuring  sulphate  of  quinine,  has  been  shown 
to  be  quinine  in  an  amorphous  state.  It  bears  the  same  relation  to 
ordinary  quinine  that  uncrystallizable  syrup  does  to  crystalline  sugar. 
In  its  purest  form  it  occurs  as  a  yellow  or  brown  resin-like  mass,  insolu- 
ble in  water — freely  soluble  in  alcohol  and  ether.  It  is  easily  soluble, 
also,  in  diluted  sulphuric  acid,  from  which  it  may  be  precipitated 
by  ammonia.  The  weight  of  this  precipitate,  when  compared  with 
that  of  the  substance  originally  employed,  affords  the  means  of  deter- 
mining the  purity  of  the  sample. 

Strychnine. — This  is  an  alkaline  body,  highly  poisonous,  found 
in  many  species  of  strychnos.  When  obtained  by  evaporation  from  its 
alcoholic  solution,  it  occurs  in  the  form  of  small,  white,  four-sided 
prisms,  or  octahedrons.  It  is  very  sparingly  soluble  in  water,  dissolves 
in  hot  and  somewhat  dilute  spirit,  but  neither  in  absolute  alcohol  nor 
ether.     With  acids,  it  forms  colorless  and  crystallizable  salts. 

Brucine. — This  is  found  in  the  bark  of  the  false  Angustura,  now 
known  to  be  the  Strychnos  nux  vomica,  L.  It  resembles  strychnine  in 
its  properties,  but  is  much  less  poisonous.  When  pure,  it  occurs  in 
colorless  rhombs,  which  are  readily  soluble  in  alcohol.  With  acids 
it  forms  salts  which  have  a  bitter  taste  and  are  generally  crystal- 
lizable. 

Emetine. — This  is  an  alkali  found  in  the  root  of  the  Cephaelis  ipeca- 
cuanha, WillcL,  and  Viola  ipecacuanha,  L.  When  completely  pure,  it 
is  white,  uncrystallizable,  nearly  tasteless,  but  very  poisonous.  It  neu- 
tralizes acids,  but  its  salts  are  little  disposed  to  crystallize. 

Yeratrine. — Found  in  the  various  species  of  Veratrum.  It  is  white, 
pulverulent,  inodorous,  of  an  acrid  taste,  but  without  bitterness.  It  is 
insoluble  in  water,  but  is  soluble  in  alcohol  and  ether,  has  an  alkaline 
reaction  and  neutralizes  acids.  Even  in  minute  quantity  it  acts  violently 
on  the  membrane  of  the  nose. 

There  are  also  Aconitine,  the  active  principle  of  the  Aconitum  napel- 

4 


44  MATERIA    NEDICA   AND   THERAPEUTICS. 

his,  L.,  or  monkshood  ;  a  very  virulent  poison  ;  Berberine,  an  organic 
base  found  in  the  Berberis  Nectrandra  rkodici  .of  Schomburgh  ; 
Baturine,  a  substance  obtained  from  the  seeds  of  the  thorn  apple, 
Datura  stramonium,  L. ;  Nicotine,  a  very  poisonous  alkaline  principle 
obtained  from  the  various  species  of  tobacco,  &c. 

Substances  someivhat  allied  to  the  preceding  but  not  alkaline. — There 
are  various  substances  somewhat  allied  to  the  preceding,  but  which  do 
not  give  an  alkaline  reaction,  nor  combine  with  acids.  The  most 
important  of  these  are,  colocyntin,  a  bitter  resinous  matter  extracted 
from  colocynth  ;  gentianin,  obtained  from  Gentiana  lutea,  B.,  or  gen- 
tian, of  a  yellowish  color,  inodorous,  but  having  the  aromatic  bitterness 
of  the  plant;  Piperin,  a  white  crystalline  substance  abstracted  from 
black  pepper;  Rliubarbarin,  the  active  principle  of  the  rhubarb; 
Salicin,  a  white  crystalline  body  obtained  from  the  bark  of  the  white 
willow,  Salix  alba,  B.,  having  a  bitter  taste  and  resembling  the  sulphate 
of  quinine ;  Thein,  the  active  principle  of  tea  and  coffee,  occurring 
in  white  anhydrous  crystals  as  the  result  of  sublimation,  &c. 


III. OLEAGINOUS,    RESINOUS,    AND    BITUMINOUS    PRINCIPLES. 

Oils  and  Fats. — Oils  are  characterized  by  a  peculiar  unctuous  feel, 
by  inflammability,  and  by  insolubility  in  water.  The  fats  seem  to  differ 
from  them  principally  in  consistency. 

The  oils  are  divided  into  fixed  and  volatile  ;  the  former  are  compara- 
tively fixed  in  the  fire,  and  therefore  give  a  permanently  greasy  stain 
•to  paper ;  while  the  latter,  owing  to  their  volatility,  produce  a  stain 
which  disappears  by  gentle  heat. 

Fixed  Oils  and  Fats. — These  bodies  in  general  have  but  feeble  odor, 
and  scarcely  any  taste.  They  are  all  insoluble  in  water,  and  but  slightly 
soluble  in  alcohol,  with  the  exception  of  castor  oil ;  in  ether  and  the 
essential  oils  they  dissolve  in  large  quantity.  By  exposure  to  the  air 
some  of  these  oils  become  hard  and  resinous,  while  others  thicken 
slightly,  become  rancid,  but  never  solidify  ;  hence  they  are  distinguish- 
ed by  the  terms  drying  and  non-drying  oils.  To  the  first  class  belong 
the  oils  used  in  painting,  as  linseed,  rape,  poppyseed,  and  walnut ;  and 
to  the  second,  olive  and  palm  oils,  and  all  the  oils  and  fats  of  animal 
origin. 

The  consistency  of  these  substances  varies  from  that  of  the  thinnest 
olive  oil,  to  that  of  solid,  compact  suet ;  the  difference  being  due  to  the 
variable  proportions  of  solid  and  fluid  fatty  principles  associated  in  the 
natural  product..  By  means  of  a  fixed  alkali  the  oil  or  fat  is  decompos- 
ed into  an  acid  which  combines  with  the  base,  forming  a  true  salt  which 


PROXIMATK    rUINCII-I.KS.  45 

is  a  snap,  and  a  substance  having  a  sweetish  taste,  and   which  is  soluble 
in  water  and  alcohol,  called  glycerin  (from  yXuxug,  «'w«7).     One  of  thee 
acids  formed  during  the  process  of 'saponification  is  called  the  stearic  acid, 

the  basis  of  which  is  stearin  (from  tfreap,  tallow),  the  solid  semi-crystal- 
line matter  of  fixed  oils  and  fats.  The  other  is  termed  olein  (from  ;Xaiov, 
c«7),  the  principal  constituent  of  the  liquid  oils  and  the  liquid  portions  of 
fats,  which  is  converted  into  oleic  acid  by  combination  with  an  alkali.    In 

most  fats,  also,  and  especially  in  that  of  the  human  body,  another  crys- 
talline substance  exists,  called  margarin,  and  which  by  combination  with 
bases  is  converted  into  glycerin  and  margaric  acid. 

To  the  above  property  of  the  fixed  oils  it  may  be  added,  that  although 
insoluble  in  water,  by  trituration  with  sugar  or  gum  they  may  be  sus- 
pended in  it,  and  they  then  form  a  class  of  preparations  which  in  phar- 
macy are  called  emulsions.  They  also  unite  with  the  common  metallic 
oxides,  forming  varnishes  and  plasters. 

Among  the  more  important  of  this  class  of  substances  are  the  fol- 
lowing : 

Olive  Oil,  expressed  from  the  fleshy  part  of  the  fruit  of  the  olive,  Olca 
europwa,  L.,  cultivated  in  France,  in  Italy,  in  Spain,  and  on  the  coast  of 
Africa.  It  has  a  fine  greenish  yellow  color,  slight  odor,  and  agreeable 
taste.  When  pure,  it  has  less  tendency  to  change  than  almost  any  of 
the  fat  oils ;  but  it  is  often  adulterated  with  inferior  oils. 

Almond  Oil,  expressed  from  the  kernel  of  the  Amygdalus  communis, 
L.  It  has  a  pale  yellow  color,  and  a  slight  but  agreeable  taste.  It  is 
used  in  pharmacy  for  the  preparation  of  emulsions ;  it  soon  becomes 
rancid  when  exposed  to  the  air. 

Rape  Oil.  A  thick  yellow  oil  expressed  from  the  seeds  of  Brassica 
rapa,  L.,  and  Brassica  napus,  L.  It  is  much  employed  in  France  for 
burning  in  lamps. 

Linseed  Oil.  The  well-known  oil  obtained  by  expression  from  the 
ripe  seeds  of  the  common  flax,  Linum  usitatissimum,  L. 

Castor  Oil.  This  is  the  Oleum  ricini  of  pharmacy,  obtained  by  ex- 
pression from  the  seeds  of  the  Ricinus  communis,  L.  It  is  a  thick,  vis- 
cid oil,  having  a  somewhat  nauseous  flavor,  often  nearly  colorless,  or 
only  of  a  pale  straw  color.  It  differs  from  most  of  the  class  by  its  beino; 
soluble  in  all  proportions  in  pure  alcohol. 

Croton  Oil,  a  thick  brownish  oil  expressed  from  the  seeds  of  the  Cro- 
ton  tiglium,  L.  It  has  a  peculiar  odor,  an  acrid  taste,  and  is  violently 
purgative  in  doses  not  exceeding  even  one  drop. 

Palm  Oil.  This  is  the  produce  of  various  species  of  palm.  It  has 
the  consistency  of  soft  tallow  or  of  butter,  an  orange  yellow  color,  and 
a  peculiar  odor.  It  soon  grows  rancid  ;  extensively  used  in  the  manu- 
facture of  soap  and  candles. 

Among  the  animal  fats  and  oils  may  be  mentioned  mutton  suet,  the 


46  MATERIA   MEDICA   AND  THERAPEUTICS. 

fat  of  sheep,  having  a -white  color  and  a  little  odor  when  fresh,  hut  acquir- 
ing a  rancid  smell  when  exposed  for  some  time  to  the  air  ;  beef  fat,  the 
fat  of  oxen,  of  a  yellowish  white  color,  and  requiring  a  heat  of  about 
100°  for  its  fusion  ;  hog's  lard,  a  white  inodorous  soft  fat,  the  fusibility 
of  which  .fluctuates  between  80°  and  88°  ;  human  fat,  which  is  soft,  yel- 
lowish, inodorous,  solid  at  about  64°  ;  whale  oil,  spermaceti  oil,  and  the 
cod  liver  oil,  or  the  oil  obtained  from  the  liver  of  the  common  cod  fish, 
Morrhua  vulgaris,  which  has  lately  been  so  much  employed  in  medi- 
cine. Under  this  head,  also,  may  perhaps  be  placed  the  different 
varieties  of  butter  and  wax. 

Volatile  or  Essential  Oils. — These  oils  are  so  named  from  their  solu- 
bility in  alcohol,  such  solutions  being  called  essences,  and  from  their  vola- 
tility. It  is  in  consequence  of  this  last  property  that  they  are  usually 
obtained  by  the  distillation  of  the  plants,  or  parts  of  plants  which  con- 
tain them,  with  water.  Some,  however,  are  obtained  by  expression,  as 
the  oils  of  lemon,  orange,  and  bergamot. 

The  essential  oils  have  a  penetrating  odor  and  taste  ;  are  for  the  most 
part  soluble  in  alcohol  and  very  sparingly  soluble  in  water.  When  pure, 
they  pass  into  vapor  at  a  temperature  somewhat  above  212° ;  but  when 
distilled  with  water  they  pass  over  at  its  boiling  point.  They  are  very 
inflammable,  and  burn  in  the  air  with  a  clear  white  light.  Their  adul- 
teration with  the  fixed  oils  can  be  determined  by  the  greasy  stain  com- 
municated to  paper,  not  being  removed  by  warming.  A  solid  crystalline 
matter,  corresponding  to  the  margarine  of  the  common  oils,  frequently 
separates  from  these  bodies  ;  it  bears  the  general  name  of  Stearoptene 
but  is  supposed  to  differ  in  almost  every  case. 

Oil  of  Turpentine. — This  is  obtained  by  distilling  with  water,  crude 
turpentine,  which  exudes  from  various  pines  and  firs.  The  oil  comes 
over  with  some  resin,  and  is  purified  by  a  second  distillation,  when  it 
forms  the  essence  or  sp>irits  of  turpentine.  The  pure  oil  is  a  thin,  color- 
less liquid,  having  a  peculiar  odor.  It  is  sparingly  soluble  in  alcohol, 
and  is  so  inflammable  that  it  becomes  dangerous  when  kept  in  large 
quantities.  By  contact  with  oil  of  vitriol  it  is  changed  into  another 
liquid  called  terebine.  With  hydrochloric  acid  it  forms  a  compound 
which  has  been  called  artificial  camphor,  from  its  resemblance  in  odor 
and  appearance  to  that  substance. 

Oil  of  Lemon. — This  is  obtained  both  by  expression  and  distillation 
from  the  rind  of  the  fruit.  It  has  the  same  composition  as  the  oil  of 
turpentine,  but  differs  from  it  in  odor.  The  oils  of  orange  feel,  bergamot, 
pepper,  juniper,  savin,  laurel  oil,  are  also  isomeric  with  the  oils  of  tur- 
pentine and  lemon. 

Oil  of  Aniseed. — The  oil  distilled  from  the  seeds  of  the  Pimpinella 
anisum,  L.,  consists  of  two  substances,  one  of  which  is  a  liquid  oil,  and 
the  other  a  solid  crystalline  substance  so  abundant  as  to  cause  the  whole 


PROXIMATE  PRINCIPLES.  47 

v 

to  solidify  at  the  temperature  of  50*.     The  solid  essence  may  be  sepa- 
rated by  pressure. 

Cam])hor. — This  is  a  concrete  essential  oil.  it  is  obtaine  I  b}  di  'il- 
lation from  the  Laurus  campkom,  />.,  nnd  several  other  plants.  I' 
subsequently  purified  by  sublimation,  and  is  then  a  white,  translucent, 
crystalline  mass,  which  is  difficult  to  powder,  and  having  a  powerful  and 
very  familiar  odor.  It  is  insoluble  in  water,  hm  freely  soluble  in  alcohol, 
from  which  it  may  be  obtained  in  the  form  of  brilliant  crystals. 

Resins  and  Balsams. — Resins  are  the  inspissated  juices  of  plants,  and 
commonly  occur  either  pure  or  in  combination  with  an  essential  oil. 
They  are  solid  at  common  temperature,  brittle,  inodorous,  and  insipid; 
generally  of  a  yellow  color ;  some  are  transparent;  soluble  in  alcohol, 
ether,  and  the  essential  oils ;  from  the  former,  they  are  precipitated  by 
water,  in  which  they  are  quite  insoluble. 

The  most  important  of  these  substances  are  common  resin,  or  rosin, 
copal,  lac,  sandarach,  rnastich,  and  dragon's  blood. 

In  pharmacy,  resins  melted  with  oil  and  wax,  are  used  to  make 
p)lasters  and  ointments. 

Gum  Resins. — These  are  the  concrete  juices  Gf  certain  plants,  and 
consist  of  resin,  essential  oil,  gum,  and  extractive  matter.  The  two 
former  are  soluble  in  alcohol,  and  the  two  latter  in  water.  Their  proper 
solvent,  therefore,  is  proof  spirit,  or  a  mixture  of  alcohol  and  water. 
Under  this  class  are  included  several  valuable  medicinal  agents,  such  as 
aloes,  ammoniacum,  assafoetida,  euphorbium,  galbanum,  gamboge,  myrrh, 
scammony,  and  guaiacum. 

Balsam. — [By  some  chemists  this  term  is  applied  exclusively  to  the 
compounds  of  benzoic  or  cinnamic  acid  with  resins.  Others  include 
among  them  some  of  what  are  more  properly  called  oleo-resins,  com- 
pounds of  resin  and  volatile  oils.  The  balsams  of  Peru  and  Tolu  are 
types  of  the  former  class ;  Canada  balsam  and  copaiva  of  the  latter.] 
They  are  generally  odorous  and  pungent.  Some  of  them  are  liquid,  as 
balsam  copaiva  and  the  balsam  of  Peru  and  Tolu  ;  others  are  solid,  such 
as  storax  and  benzoin. 

Caoutchouc,  commonly  called  elastic  gum,  or  India  rubber,  is  the 
produce  of  the  Siphonia  elastica,  JPers.,  a  native  of  Brazil,  and  of 
several  East  India  trees,  which  yield  milky  juice,  hardening  by  exposure 
to  the  air.  In  a  pure  state,  it  is  nearly  white,  the  dark  color  of  the 
common  caoutchouc  being  caused  by  smoke  and  other  impurities.  The 
most  remarkable  property  of  this  substance  is  its  elasticity.  It  is  inflam- 
mable, and  burns  with  a  bright  flame.  In  water  and  alcohol  it  is  per- 
fectly insoluble.      The  best  solvents  are  petroleum,  purified  naphtha,  oil 


48  MATERIA   HEDICA   AND   THERAPEUTICS. 

of  turpentine,  coal  oil,  and  especially  the  thin  oily  liquid  obtained  from 
the  distillation  of  the  caoutchouc  itself.  In  a  state  of  solution  it  is 
employed  for  forming  varnishes,,  for  covering  cloth  so  as  to  render  it 
■water  proof,  &c. 

Gutta  Percha. — The  concrete  milky  juice  of  the  Isonandria  Gutta 
(Hooker),  a  tall  tree,  native  of  Singapore  and  the  Malay  Islands.  As 
imported,  gutta  percha  is  a  whitish,  opaque  solid  ;  density,  0.79.  Not 
acted  on  by  water,  alcohol,  alkaline  solutions,  muriatic  and  acetic  acids. 
It  is  charred  by  sulphuric  acid,  and  readily  dissolved  by  spirits  of  turpen- 
tine. In  hot  water  it  softens,  becomes  plastic  and  readily  welded  by 
pressure.  "When  cool  it  resumes  its  hard,  tough  state.  It  is  very 
extensively  used  in  the  arts.  A  solution  of  it  in  ether  has  been  recom- 
mended as  a  dressing  to  wounds. 


IV. ALCOHOLIC   AND    ETHEREAL    PRINCIPLES. 

Alcohol. — This  principle  does  not  exist  ready  formed  in  plants,  but 
is  the  product  of  vinous  fermentation,  and  is  the  intoxicating  ingredient 
of  all  spirituous  and  vinous  liquors.  In  its  pure  form  it  is  a  limpid, 
colorless  liquid,  having  a  penetrating  odor  and  burning  taste.  The 
lightest  that  can  be  obtained  by  simple  distillation,  has  a  specific  gravity 
of  0*825r  but  by  other  processes  it  has  been  brought  to  the  specific 
gravity  of  0-7947,  at  60°.  In  that  state  it  boils  at  168°,  and  does  not 
become  solid  even  in  the  most  intense  cold.  It  is  highly  inflammable, 
burning  with  a  pale  bluish  flame,  and  yields  carbonic  acid  and  water  as 
the  products  of  its  combustion.  It  is  remarkably  expansible  by  heat ; 
unites  in  all  proportions  with  water,  the  combination  being  usually 
attended  with  a  diminution  of  volume  and  an  increase  of  temperature. 
The  solvent  powers  of  alcohol  are  very  extensive,  many  salts,  various 
organic  bodies,  as  the  alkalies,  resins,  essential  oils,  <fec,  being  soluble  in  it. 

Common  alcohol,  or  spirits  of  wine,  is  prepared  by  distilling  whiskey 
or  some  ardent  spirit,  and  the  rectified  spirit  of  wine  is  procured  by 
a  second  distillation.  The  first  has  a  specific  gravity  of  about  0*867,  and 
the  last  of  about  0-835  or  0*840. 

Equal  weights  of  absolute  alcohol  and  water  constitute  proof  spirit, 
the  density  of  which  is  0*917;  but  the  proof  spirit  employed  for  tinc- 
tures has  a  specific  gravity  of  0*935  to  0*940.  Tables  are  constructed, 
showing  the  specific  gravities  of  various  mixtures  of  alcohol  and  water. 

Wine  and  other  fermented  liquors  contain  variable  proportions  of 
ready  formed  alcohol,  to  which  they  owe  their  intoxicating  properties. 

Ether. — This  term  is  now  applied  to  various  compounds  usually 
produced  by  the  action  of  acid  upon  alcohol.  These  substances  are 
characterized  by  their  extreme  volatility  and  inflammability. 


PROXIMATE   PRINCIPLES.  49 

Sulphuric  ether  is  obtained  by  the  application  of  heat  to  a  mixture 
of  equal  weights  of  rectified  spirit  ami  oil  of  vitriol,  and  condensing  the 
product.  It  is  a  colorless,  transparent  liquid,  of  a  hot  and  pungent  taste 
and  fragrant  odor.  In  its  present  form  it  has  a  specific  gravity  of  about, 
0-720,  at  GO0,  and  is  so  very  volatile  that  when  a  few  drops  arc  poured 
on  the  hand,  the  evaporation  instantly  causes  a  considerable  reduction 
of  temperature.  It  has  for  some  years  past  been  largely  employed  by 
the  physicians  on  account  of  its  anaesthetic,  or  pain-subduing  property. 

Nitrous  or  Hyponitrous  ether,  is  procured  by  the  action  of  byponi- 
trous  acid  vapor  upon  alcohol.  It  is  a  volatile  liquid  of  a  pale  yellow- 
color  and  an  agreeable  odor;  specific  gravity  at  GO",  0"947. 

The  sxveet  spirits  of  nitre  is  prepared  by  distilling  three  pounds  of 
alcohol  with  four  ounces  of  nitric  acid. 

Hydrochloric  ether,  prepared  by  distilling  a  mixture  of  oil  of  vitriol, 
common  salt,  and  alcohol,  is  a  colorless  liquid,  having  a  pungent  garlic 
odor,  and  a  specific  gravity  of  0-874.  To  this  may  also  be  added  Hy- 
drobromic  ether,  Hydriodic  ether,  Oxalic  ether,  Acetic  ether,  Butyric 
ether,  Valerianic  ether,  Formic  ether,  etc.,  all  of  which  are  liquids  simi- 
larly obtained.  The  whole  class  have  a  common  base,  to  which  the 
name  of  ethyl  has  been  applied. 

Chloroform. — This  substance,  which  has  recently  attracted  great 
attention  in  consequence  of  its  remarkable  anaesthetic  property,  was 
discovered  in  1831  by  Samuel  Guthrie  of  Sacket's  Harbor,  and  about 
the  same  time  by  Soubeiran  of  Paris  and  Liebig  in  Germany.  It  may 
be  obtained  by  distilling  alcohol,  wood  spirit,  or  acetone,  with  a  solution 
of  chloride  of  lime.  It  is  a  thin,  colorless  liquid,  of  an  agreeable 
ethereal  odor  and  a  sweetish  taste.  Its  specific  gravity  is  from  1*493 
to  1*497.  It  is  with  difficulty  kindled,  and  burns  with  a  greenish  flame. 
It  is  liable  to  several  impurities,  and  is  said  to  be  decomposed  under 
the  influence  of  air  and  light,  with  the  evolution  of  chlorine,  hydro- 
chloric acid,  and  formation  of  other  products ;  but  it  does  not  seem  to 
be  altered  when  preserved  under  water. 


V. SUGARS  AND  THEIR  CONGENERS. 

Sugars. — There  are  several  substances  which  are  known  to  agree  in 
having  a  sweet  taste,  but  which  differ  in  several  other  respects.  Some 
of  them,  when  dissolved  in  water  and  mixed  with  yeast,  undergo  the 
alcoholic  fermentation,  while  others  are  not  susceptible  of  this  change. 
To  the  former  class  belong  cane  sugar,  grape  sugar,  starch  sugar,  milk 
sugar,  mushroom  sugar,  <fec. ;  to  the  latter,  liquorice  sugar  and  manna 
sugar. 

Cane-sugar. — This  is  found  in  the  juice  of  many  plantsrbut  is  derived 


50  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

in  large  quantities  from  the  sugar  cane,  the  sugar  maple,  and  the  beet 
root.  From  a  strong  solution  of  the  purified  syrup,  large,  transparent, 
colorless  crystals  of  sugar  may  be  obtained  having  the  form  of  a  modi- 
fied oblique  prism.  It  has  a  pure  sweet  taste,  is  soluble  in  water,  melts 
when  rnodgrately  heated  and  cools  into  a  glassy  amorphous  mass,  but 
at  a  higher  temperature  it  blackens  and  is  decomposed.  When  mixed 
with  yeast  it  readily  ferments,  but  the  first  action  of  the  ferment  seems 
to  be  the  conversion  of  cane  sugar  into  grape  sugar,  the  only  species 
which  is  supposed  to  be  directly  fermentable. 

Grape  Sugar. — This  is  the  sweet  principle  of  grapes,  figs,  and  most 
acid  fruits  ;  it  exists  also  in  honey,  and  is  the  sugar  of  diabetic  urine. 
It  may  also  be  obtained  artificially  by  the  action  of  dilute  acids  upon 
several  other  substances,  as  cane  sugar,  starch,  lignin,  &c.  It  is  neither 
so  sweet  nor  so  soluble  in  water  as  cane  sugar,  and  in  its  mode  of  crys- 
tallization is  moreover  completely  different. 

Sugar  of  Milk  exists  in  the  liquid  from  which  it  derives  its  name, 
and  occurs  in  the  form  of  hard,  white,  translucent,  four-sided  prisms. 
Under  particular  circumstances  it  furnishes  alcohol. 

Manna  Sugar  is  the  chief  component  of  manna,  which  exudes  from 
various  trees,  especially  from  the  ash,  Fraxinus  omus,  L. ;  liquorice 
sugar,  a  sweet  unfermentable  substance  found  in  the  root  of  the  liquo- 
rice, Glycyrrhiza  glabra,  L. 

Gum. — This  principle  is  of  very  common  occurrence  in  the  vegetable 
kingdom.  The  most  perfect  type  of  the  class  is  gum  arabic,  which  is 
the  hardened  juice  of  various  species  of  Acacia.  It  forms  small  trans- 
parent masses  of  a  pale  yellow  color,  which  are  inodorous  and  nearly 
tasteless.  With  water  it  forms  a  viscid,  adhesive  solution  usually  called 
mucilage,  but  the  same  term  is  also  applied  to  a  substance  obtained 
from  linseed,  the  roots  of  the  mallow,  &c,  which  differs  in  some  respects 
from  the  preceding. 

Gum  Tragacanth  is  the  produce  of  certain  species  of  Astragalus.  It 
is  in  the  form  of  yellowish-white,  transparent  flakes,  which  do  not  dis- 
solve in  water,  but  when  steeped  in  it  swell  into  a  mucilaginous  mass. 
It  contains  a  substance  called  bassorine. 

Cherry  Tree  Gum  and  that  of  the^mcA  and  apricot  trees,  resemble 
inferior  gum  arabic  in  appearance,  but  are  only  partially  soluble  in 
water. 

Lignin. — This  is  the  substance  which  remains  when  wood  has  been 
successively  treated  by  various  agents,  so  that  all  the  soluble  matters 
are  removed.  When  pure,  it  is  destitute  of  smell,  taste,  and  color;  by 
hot  nitric  acid  it  is  converted  into  oxalic  acid,  and  by  sulphuric  acid 
changed  into  gum  or  dextrine,  and  at  length  into  sugar. 


PROXIMATE    PRINCIPLES.  5  1 

Starch  or  Fecuxa. — This  is  one  of  the  most  importanl  and  widely 
diffused  vegetable  proximate  principles,  being  found  in  a  great  number 
of  plants.  It  is  most  abundant  in  certain  roots  and  tubers,  as  the  po- 
tatoc,  from  which  it  may  be  obtained  by  rasping  the  Bubstance,  placing 
it  upon  a  sieve,  and  washing  it  with  cold  water.  The  Btarch  pa 
through  with  the  liquid,  and  settles  down  from  the  latter  as  a  white, 
insoluble  powder,  which  may  be  washed  with  cold  water  arid  dried  at  a 
very  gentle  heat.  From  grain  starch  maybe  procured  by  mixing  the 
meal  with  water  to  a  dough,  and  then  washing  it  upon  a  sieve  or  coarse 
linen  cloth,  and  treating  it  as  before.  A  yellowish  white,  tough  sub- 
stance remains  behind,  called  gluten,  to  which  the  nutritious  property 
of  the  meal  is  chiefly  ascribed.  This  product  differs  from  starch  in 
containing  nitrogen.  By  boiling  alcohol  the  gluten  is  dissolved,  while 
another  principle,  vegetable  albumen,  remains  behind. 

Starch  is  insoluble  in  cold  water,  alcohol,  and  ether.  In  boiling 
water  it  is  soluble.  The  best  test  is  the  blue  color  which  it  forms  with 
iodine.  By  being  boiled  in  dilute  sulphuric  acid  it  is  first  changed 
into  a  body  resembling  gum,  and  then  into  starch  or  grape  sugar. 

Arrow  Root,  prepared  from  the  root  of  the  Maranta  arundinacea, 
L.,  has  all  the  characters  of  pure  starch.  Sago,  obtained  from  the 
pith  of  the  Cycas  circinalis,  L.,  and  Tapioca,  from  the  root  of  the 
Jatropha  manihot,  L.,  are  chemically  the  same  substance. 

Dextrine  or  British  gum  is  prepared  by  heating  dry  potatoe-starch 
to  about  400°.     It  is  soluble  in  cold  water. 

I  might  here  add  notices  of  animal  albumen,  fibrin,  and  casein, 
which  have  been  proved  to  be  identical,  or  nearly  so,  with  principles 
found  in  plants ;  but  the  history  of  these  bodies  is  more  intimately  con- 
nected with  the  department  of  physiology,  and  I  shall,  therefore,  not 
enter  into  a  description  of  them. 


EMETICS 


The  term  emetic  literally  means  a  substance  which  causes  vomiting. 
Emetics  have  been  accordingly  defined  to  be  those  substances  which 
excite  vomiting.  In  its  application,  however,  to  the  class  of  agents 
called  emetics,  this  definition  is  altogether  too  comprehensive ;  various 
substances  which  are  not  emetics  frequently  produce  vomiting.  Thus, 
overloading  the  stomach  with  food,  or  swallowing  something  nauseous 
or  irritating,  may  be  followed  by  this  effect.  Emetics  may,  therefore, 
more  correctly  be  defined  to  be  those  agents  which  by  some  peculiar 
or  specific  operation  excite  vomiting. 

As  a  class  of  medicinal  agents,  emetics  have  been  in  use  from  the 
earliest  periods,  and  in  their  action  they  are  of  the  most  interesting 
character.  Apparently  simple,  they  nevertheless  affect  the  system 
most  profoundly,  scarcely  any  organ  or  tissue  escaping  from  their 
immediate  or  remote  influence.  Vomiting,  although  the  most  striking, 
is  only  one  of  the  series  of  important  effects  which  they  produce  ;  and 
to  appreciate  justly  their  uses  and  applications,  it  is  necessary  to  under- 
stand thoroughly  all  these  effects.  I  shall  trace  these  effects  as 
minutely  as  possible,  with  a  view  of  establishing  some  general  principles 
in  relation  to  their  uses  in  various  diseases.  In  discussing  this  class  of 
remedies,  I  shall  notice, 

1.  The  organs  immediately  concerned  in  the  act  of  vomiting. 

2.  The  effects,  local  and  general,  which  emetics  produce. 

3.  The  circumstances  modifying  these  effects. 

4.  The  conditions  of  the  system,  favorable  and  unfavorable  to  their  uses. 

5.  The  different  modes  of  introducing  them  into  the  system. 

6.  The  rules  to  be  observed  in  their  administration. 

7.  The  uses  and  applications  of  them  in  various  diseases. 

Of  the  organs  immediately  concerned  in  the  act  of  vomiting. — These 
are  the  stomach,  the  duodenum,  the  liver,  the  gall-bladder,  the  pan- 
creas, the  diaphragm,  and  abdominal  muscles.  On  the  minute  anatomy 
of  these  organs  it  is  not  my  intention  to  enter.  I  propose  only  to  notice 
such  circumstances  connected  more  particularly  with  the  stomach,  as 
may  throw  some  light  upon  the  operation  of  the  agents  under  exami- 
nation. 

The  stomach  is  a  musculo-membraneous  bag,  generally  compared  in 
its  shape  to  the  pouch  of  a  bagpipe  ;  it  is  situated  across  the  abdomen, 
directly  below  the  diaphragm,  partly  in  the  left  hypochondriac  region 


KMKTIC8.  53 

and  partly  in  the  epigastrium.  It  1ms  two  orifices — the  cardiac,  which 
connects  it  with  the  termination  of  the  oesophagus;  and  the  pyloric, 
which  connects  it  with  the  duodenum.  The  stomach  is  made  up  of 
three  different  structures  or  coats — the  serous  or  external  coat,  the 
mucous  or  internal  lining,  and  the  muscular,  intermediate  between  the 
two;  all  three  united  together  by  cellular  tissue.  It  is  the  two  last 
which  are  more  especially  worthy  of  notice,  in  connexion  with  our 
subject.  The  muscular  coat  is  not,  as  its  name  would  indicate,  a  con- 
tinuous membrane,  but  consists  of  separate  strata  of  fibres,  some  of 
which  are  longitudinal,  while  others  are  circular.  It  is  by  this  coat 
that  the  contractions  of  the  stomach  arc  caused,  and  from  the  peculiar 
distribution  of  the  fibres  in  separate  groups,  this  organ  possesses  the 
power  not  merely  of  contracting  in  all  directions,  but  different  portions 
of  it  contract  and  relax  successively,  and  thus  produce  what  is  called  its 
peristaltic  or  vermicular  motion. 

The  mucous  membrane  is  of  a  soft,  velvet-like  appearance,  and  has  a 
pale  red  color.  It  has  no  power  of  contraction.  When  the  muscular 
coat  contracts,  the  mucous  membrane  is  thrown  into  numerous  folds  or 
rug£e,  chiefly  longitudinal,  which  disappear  entirely  when  the  stomach 
is  laid  open  and  spread  out.  The  mucous  membrane  has  a  great  number 
of  depressions,  in  which  are  found  the  minute  openings  of  the  glands 
which  secrete  the  gastric  juice.     Muciparous  glands  abound  in  it. 

As  might  naturally  be  inferred  from  the  great  importance  of  the 
stomach  in  the  animal  economy,  it  is  very  plentifully  supplied  with 
blood-vessels  and  nerves — scarcely  any  organ  in  the  whole  body  more 
so.  Its  nerves  are  numerous  and  various,  being  received  from  both  the 
cerebral  and  ganglionic  systems. 

The  Duodenum. — Of  this  organ  it  is  only  necessary  to  state  that  it  is 
analogous  in  its  structure  to  the  stomach,  except  that  it  is  not  furnished 
with  a  distinct  serous  coat — it  has  a  muscular  and  mucous  covering. 
The  mucous,  being  more  extensive  than  the  muscular,  is  thrown  into 
transverse  folds,  which  are  called  valvulae  conniventes,  and  upon  its  inner 
surface  are  A  number  of  mucous  follicles.  In  the  interior  of  the  duo- 
denum, about  its  middle,  is  a  small  tubercle,  at  the  point  of  which  are 
seen  the  orifices  of  the  ductus  communis  choledochus,  and  the  pancreatic 
duct.  Sometimes  these  are  united,  aud  open  by  one  orifice  into  the 
intestine. 

Liver  and  Gall-bladder. — These  organs  communicate  with  the  duo- 
denum by  means  of  the  ductus  communis  choledochus.  This  duct  is 
made  by  the  union  of  the  hepatic  and  cystic,  and  it  is  through  these 
that  the  bile  is  conveyed  from  the  liver  aud  gall-bladder.  The  gall- 
bladder is  so  situated,  that,  when  pressure  is  made  upon  the  abdominal 
organs  by  the  strong  contraction  of  the  abdominal  muscles,  its  contents 
are  more  or  less  freely  evacuated. 


54  MATERIA    MEDICA   AND   THERAPEUTICS. 

The  Pancreas. — This  organ  also  secretes  a  fluid  which  is  poured  into 
the  duodenum  by  the  pancreatic  duct.  All  these  ducts  have  the  same 
lining  of  mucous  membrane  as  the  stomach  and  duodenum. 


EFFECTS    OF    EMETICS    ON    THE    SYSTEM. 

When  an  emetic  is  first  taken,  no  immediate  effect  is  produced.  In 
about  a  quarter  of  an  hour,  sooner  or  later  according  to  the  article  taken, 
state  of  the  system,  &c,  an  uneasy  sensation  begins  to  be  experienced  in 
the  epigastric  region,  accompanied  with  nausea  and  slight  dizziness. 
These  sensations  gradually  increase — the  pulse  becomes  small,  frequent, 
and  irregular — the  face  is  pale  and  the  surface  chilly — the  lower  lip 
trembles,  and  saliva  begins  to  flow  ;  convulsive  contractions  of  the  dia- 
phragm and  abdominal  muscles  now  take  place,  which  are  shortly 
succeeded  by  actual  vomiting.  During  the  time  that  vomiting  is  going 
on,  the  face  becomes  flushed  and  turgid,  the  pulse  increases  in  fulness 
and  strength,  there  is  a  glow  on  the  surface,  and  the  whole  system, 
nervous,  vascular,  and  muscular,  experiences  a  general  agitation.  As 
soon  as  the  vomiting  ceases,  the  nausea  goes  oftyandthe  system  is  left  in 
a  state  of  languor,  accompanied  with  moisture  on  the  surface  and  a  dis- 
position to  sleep.  By  an  ordinary  emetic,  the  process  of  vomiting  is 
generally  excited  three  or  four  times,  at  short  intervals.  After  the 
operation  of  the  emetic,  the  pulse  will  be  found  slow  and  feeble,  with 
general  relaxation  of  the  system,  showing  itself  particularly  in  the 
cerebral  and  muscular  systems,  the  skin,  and  sometimes  in  the  bowels ; 
languor,  debility,  and  drowsiness ;  the  skin  cool  and  moist;  sometimes 
copious  discharges  from  the  bowels. 

Such  are  the  ordinary  visible  effects  of  an  emetic.  For  the  purpose, 
however,  of  understanding  more  fully  the  important  changes  which  are 
wrought  by  emetics  upon  particular  organs,  it  will  be  necessary  to  go  a 
little  more  into  the  detail. 

On  the  Local  Effects. — When  an  emetic  is  swallowed,  it  comes  in 
immediate  contact  with  the  mucous  membrane  of  the  stomach,  and 
upon  this  makes  a  peculiar  impression,  the  first  effect  of  which  is  to  pro- 
duce an  increase  of  secretion  from  its  exhalant  vessels  and  mucous 
follicles.  This  is  abundantly  shown  by  the  character  of  the  evacuations 
which  are  thrown  off  from  the  stomach  in  the  act  of  vomiting.  The 
impression  thus  made  differs  greatly  in  degree,  according_  to  the  nature 
of  the  article  used,  and  more  especially  according  to  the  dose  in  which 
it  is  given.  Generally,  where  the  doses  are  moderate,  this  primary 
impression  is  mild  and  transitory,  merely  promoting  secretion.  In  some 
cases,  however,  especially  where  the  doses  have  been  larger,  irritation 


EMETICS*  55 

and   inflammation  have  been    the    consequence.      Tartar   emetic    riot 
unfrequently  produces  these  effects. 

Remote  Effects. —  On.  the  Brain  awl  Arervous  System. —  It.  i.  here 
that  the  first  remote  effect  of  emetics  i:  felt.  During  the  different 
stages,  however,  of  their  operation,  it  varies.  Shortly  after  th#e 
stance  is  received  into  the  stomach,  the  brain  is  affected  :  vertigo  and 
debility  indicating  a  diminution  of  general  power  in  this  organ.  As 
soon  as  actual  vomiting  occurs,  a  genera]  shock  is  given  to  tin-  brain  j 
and  this  is  followed,  after  the  process  of  vomiting  is  completed,  hy  a 
state  of  impaired  energy,  with  a  tendency  to  sleep.  Emetics,  then, 
although  during  the  act  of  vomiting  they  give  a  temporary  impulse  to 
the  brain,  are  essentially  debilitating  to  that  organ,  as  well  as  to  the 
whole  nervous  system. 

On  Ike  Mucous  System. — As  already  stated,  the  primary  effect  of 
emetics  is  to  produce  secretion  from  the  mucous  membrane  of  the 
stomach.  This  is  soon  extended  to  other  portions  of  the  mucous 
system,  that  of  the  oesophagus,  the  mouth,  the  trachea,  and  the  bron- 
chial tubes,  from  all  of  which  an  increase  of  secretion  takes  place  during 
the  operation  of  an  emetic.  The  evidences  of  this  fact  are  strikingly 
seen  in  certain  states  of  disease.  Thus,  for  example,  a  dry,  coated 
tongue  not  unfrequently  becomes  moist  and  clean ;  and  from  the 
mucous  membrane  of  the  lungs  free  secretion  and  expectoration  take 
place.  Not  unfrequently  the  same  effect  is  extended  to  the  mucous 
membrane  lining  the  intestinal  canal,  as  is  shown  by  the  increased 
evacuations  from  the  bowels.  Other  portions  of  the  mucous  mem- 
brane are,  no  doubt,  simultaneously  affected.  The  general  effect,  then, 
on  this  system  is  to  produce  a  change  of  action,  and  an  increase  of 
secretion. 

On  the. Vascular  System. — AYhen  an  emetic  first  begins  to  affect  the 
stomach,  previously,  however,  to  vomiting,  the  blood  retires  from 
the  surface  of  the  body  to  the  internal  organs.  Hence  the  skin 
at  this  period  is  cocl  and  the  face  pale.  In  consequence,  too,  of  the 
diminished  energy  of  the  heart,  and  the  consequent  inability  of  that 
organ  to  throw  the  blood  into  the  extreme  vessels,  the  pulse  is  frequent 
and  small.  As  soon  as  actual  vomiting  comes  on,  a  re-action  in  the 
whole  vascular  system  takes  place,  and  the  blood  is  driven  back  again 
to  the  surface,  and  it  is  owing  to  this  that  the  skin  becomes  warmer 
and  the  pulse  falls  during  this  period.  In  addition  to  this,  a  great 
accumulation  of  blood  about  the  head  takes  place  during  the  act 
of  vomiting,  as  is  indicated  by  the  flushed  face  and  the  beating  of  the 
large  vessels.  This  is  occasioned  not  by  any  increased  determination  to 
this  organs  but  by  an  interruption  in  the  return  of  blood,  resulting 
from    the    pressure    made    upon    the  descending  cava,    and  from  the 


56  MATERIA    MEDICA    AND   THERAPEUTICS. 

impeded  respiration  producing  a  temporary  obstruction  in  the  pulmonary 
circulation.  After  the  emetic  has  completed  its  operation,  and  the  sys- 
tem has  recovered  from  the  mechanical  agitation  connected  with  the 
process  of  vomiting,  the  circulation  is  left  in  a  state  of  impaired  energy, 
and  the  pulse  will  be  found  soft  and  diminished  in  frequency. 

On  the  Glandular  System. — Several  of  the  more  important  glands 
are  conspicuously  affected  during  the  operation  of  emetics.  Thus  the 
salivary  glands,  the  liver,  the  pancreas,  and  the  kidneys,  are  all  excited 
into  action,  and  increased  secretion  produced  from  them.  "With  regard 
to  the  liver,  it  is  not  in  every  case,  nor  by  every  emetic,  that  it  is  thus 
excited ;  frequently,  however,  it  is  so  very  powerfully,  and  then  large 
quantities  of  bile  are  discharged  by  vomiting.  That  such  an  effect  is 
actually  produced  upon  the  liver,  is  proved  both  by  the  nature  of  the  bile 
which  is  discharged,  as  well  as  by  its  quantity.  At  the  same  time  the  liver 
is  excited  to  increased  action,  the  gall-bladder  is  more  or  less  emptied  of 
the  bile  which  it  may  happen  to  contain.  This  is  mainly  effected  by 
the  mechanical  pressure  made  by  the  surrounding  parts  upon  this  organ 
during  the  act  of  vomiting.  This  will  be  noticed  more  fully  when 
I  come  to  speak  of  the  character  of  the  discharge  produced  by  emetics. 
Upon  the  Pancreas  the  same  effect  is  produced  as  on  the  liver,  and 
increased  secretion  takes  place. 

On  the  Respiratory  System. — This  is  powerfully  affected  by  the  action 
of  emetics,  and  in  different  ways.  In  the  first  place,  secretion  is  increas- 
ed from  the  mucous  membrane  of  the  lungs ;  in  the  second  place,  from 
the  violent  and  successive  contractions  of  the  abdominal  muscles,  as 
well  as  from  the  general  shock  given  to  the  pulmonary  system  in  the  act 
of  vomiting,  mucous  accumulations  are  dislodged  and  expelled. 

On  the  Absorbent  System. — With  regard  to  the  effect  of  emetics  on 
the  absorbents,  there  is  a  difference  in  opinion.  Some  contend 
that  they  quicken  the  action  of  these  vessels,  and  the  fact  adduced 
in  support  of  it  is  the  rapid  disappearance  of  tumors  under  the  use 
of  emetics.  The  manner  in  which  this  takes  place  is  thus  explained. 
It  appears  to  be  a  law  of  the  animal  economy  that  absorption  goes 
on  in  the  inverse  ratio  of  the  fulness  of  the  blood-vessels.  When  the 
system  is  plethoric,  absorption  is  much  less  active  than  in  an  opposite 
condition.  Hence  blood-letting  and  starvation  promote  absorption. 
Now  emetics  lower  the  force  of  the  circulation,  and  just  in  proportion 
to  the  degree  in  which  they  produce  this  effect,  do  they  appear  to 
promote  absorption.  Hence  it  has  been  found  that  those  emetics  which 
cause  the  greatest  degree  of  nausea  are  most  effective  in  the  removal  of 
tumors. 

On  the  Cutaneous  System. — The  effect  of  emetics  on  the  skin  varies 
during  the  different  stages  of  their  operation.  During  the  nausea 
which  precedes  vomiting  the  skin  is  cool  and  pale  ;  in  the  act  of  vomit- 


EMETICS.  ~)1 

ing,  it  becomes  warm  and  flushed;  after  the  operation  is  complete,  it  is 
left  soft,  moist,  and  relaxed.  This  is  owing  partly  to  the  nau  a 
and  partly  to  the  powerful  determination  of  the  blood  to  the  capillaries 
of  the  surface  during  the  act  of  vomiting.  The  agency  of  nausea  in 
producing  this  effect  is  proved  by  the  fact,  that  those  emetics  which  are 
attended  with  the  most  sickness,  produce  the  greatest  relaxation  of  the 
surface. 

On  the  Muscular  System. — During  the  act  of  vomiting  violent  mus- 
cular contraction  is  produced.  This  is  succeeded,  after  the  completion 
of  the  operation,  by  a  diminution  in  the  tone  and  energy  of  the  whole 
muscular  system.  This  is  strikingly  evinced  in  the  languor,  debility, 
and  indisposition  to  motion  which  are  present.  This  effect  is  also  pro- 
portioned to  the  degree  of  nausea  which  is  produced. 

On  the  Urinary  System. — The  general  effect  of  emetics  is  to  increase 
the  secretion  of  urine.  Occasionally,  however,  actual  suppression  of 
urine  takes  place.  Dr.  Heberderi  relates  a  case  of  this  kind  occurring  in 
a  female,  and  Mr.  Brande  mentions  another  in  which  no  urine  was  se- 
creted for  twenty-four  hours  after  the  vomiting. 

With  regard  to  the  effects  of  emetics  it  is  to  be  recollected  that  they 
differ  considerably,  according  to  the  article  which  is  used.  Some  ope- 
rate with  great  rapidity,  while  others  are  slower.  Some  produce  much 
more  nausea  than  others,  while  some  produce  much  greater  prostration 
of  system. 

From  the  foregoing  analysis,  it  is  evident  that  the  agency  of  emetics 
is  of  a  complicated  character.  In  their  primary  action  they  impress  the 
gastric  tissue  and  promote  secretion  from  it.  During  the  acts  of  vomit- 
ing, they  agitate  and  convulse  the  whole  system.  In  their  remote  ope- 
ration, they  affect  almost  every  organ  and  tissue  of  the  body.  They  are 
remedies  of  great  power  and  pervading  influence.  When,  therefore,  you 
are  giving  an  emetic  do  not  imagine  that  you  are  merely  emptying  a 
man's  stomach  :  this,  as  already  stated,  is  frequently  the  least  important 
of  their  effects ;  consider  them  always  in  the  light  in  which  they  have 
been  represented. 


OF    THE  VARIOUS  CIRCUMSTANCES  MODIFYING/  THE  EFFECTS  OF  EMETICS. 

(a.)  Of  Age. — As  regards  the  mere  mechanical  act  of  vomiting,  chil- 
dren perform  it  more  easily  than  adults.  The  reasons  of  this  are  various. 
One  is  that  the  abdominal  viscera  in  children  have  a  much  greater  pro- 
portional volume,  and  thus  aid  in  making  the  compression  of  the  stomach 
so  essential  to  the  act  of  vomiting.  Another  reason,  and  one  which  has 
but  recently  been  investigated,  is  the  difference  in  the  shape  of  the 


58  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

stomach  of  the  infant  and  the  adult.  For  the  elucidation  of  this  most 
interesting  fact  we  are  indebted  to  Professor  Schultz  of  Germany.  By 
him  it  has  been  shown  that  the  stomach  of  the  child  is  peculiarly  favor- 
able to  the  expulsion  of  its  contents,  and  that  as  we  advance  in  life  to 
adult  age,-  it  undergoes  an  important  change  in  its  shape,  by  which  its 
evacuation  is  rendered  more  and  more  difficult.* 

Notwithstanding  this  facility  of  vomiting,  it  is  to  be  recollected  that 
the  mucous  membrane  in  children  is  much  more  delicate  and  sensitive 
to  impressions  and  irritations  than  it  is  in  the  more  advanced  periods  of 
Ijfe.  In  consequence  of  this,  as  well  as  the  general  feebleness  of  their 
organization,  they  cannot  so  well  sustain  the  effects  of  those  emetics  which 
powerfully  debilitate  the  system.  On  this  account  antimonial  emetics 
are  frequently  hazardous  to  young  children.  Dr.  Clarke  states  that  "  a 
quarter  of  a  grain  of  tartrate  of  antimony  in  solution,  has  been  known  to 
excite  a  vomiting  which  has  ended  in  the  death  of  a  young  child,  which 
before  was  in  no  danger."f  Dr.  Armstrong  states  that  he  has  seen  seve- 
ral cases  in  which  delirium  has  resulted  from  the  use  of  antimony  in 
young  children. J  I  have  known  a  case  in  which  the  one-thirtieth  part 
of  a  grain  of  tartar  emetic,  given  to  a  child  of  one  year  old,  laboring 
under  croup,  produced  such  severe  and  protracted  vomiting  and  general 
prostration  as  to  require  stimulants  to  save  life. 

Previous  to  the  time  of  Sydenham,  no  other  active  emetics  were 
known  than  those  prepared  from  antimony,  and  the  want  of  some  other 
emetic  both  efficient  and  safe  was  a  matter  of  regret  with  this  great 
man. 

In  old  age,  the  effects  of  emetics  are  also  considerably  modified.  Al- 
though, from  the  impaired  sensibility  of  the  mucous  membrane  of  the 
stomach  and  bowels  at  this  period  of  life,  little  danger  is  to  be  appre- 
hended from  any  local  irritation,  yet  active  emetics,  especially  tartar 
emetic,  not  unfrequently  produce  great  and  even  dangerous  prostration. 
There  is  another  circumstance  which  renders  the  use  of  these  articles  at 
this  age  exceedingly  hazardous — the  tendency  which  there  exists  to  con- 
gestions, more  especially  of  the  brain.  Hence  the  mechanical  act  of 
vomiting  may  be  followed  by  fatal  results. 

(b.)  Sex, — As  the  constitution  of  females  is  less  vigorous,  and  their 
nervous  systems  more  excitable  than  those  of  males,  as  a  general  rulej 
they  will  not  bear  such  large  closes  of  emetic  medicines,  nor  will  they 
bear  so  well  the  more  debilitating  articles  of  this  class.  Care  and  cau- 
tion, therefore,  are  to  be  taken  with  regard  to  their  quantity,  as  well  as 
the  character  of  the  articles  used.     During  pregnancy,  emetics  should 


*  The  British  and  Foreign  Review,  No.  4,  p.  539. 

|  Clarke  on  the  Diseases  of  Children,  p.  33. 

\  Lectures,  &c,  by  John  Armstrong,  M.D.,  p.  248. 


EMETICS.  .09 

be  prescribed  with  great  caution.  Daring  the  advanced  months  parti- 
cularly, they  arc  remedies  attended  with  a  good  deal  of  danger.     Prom 

the  distended  condition  of  the  abdominal  muscles,  the  vomiting  is  inef- 
fectual and  painful,  and  not  unfrequently  followed  by  the  premature 

expulsion  of  the  foetus.  This,  in  fact,  is  one  of  the  modes  in  which  arti- 
ficial abortion  is  attempted  to  be  accomplished. 

Meckel  says,  "the  stomach  is  larger,  shorter,  and  broader  in  the 
male — smaller,  narrower,  and  longer  in  the  female." — V.  iii.  p.  2G2. 

Women  have  to  vomit  a  good  deal  in  pregnancy.  Is  not  this  a  wise 
provision  to  facilitate  the  operation  ? 

(c.)  Peculiar  Constitution  of  Body. — As  a  general  rule,  persons  of 
robust  constitutions,  although  they  may  not  perform  the  mechanical  act 
of  vomiting  with  more  ease  than  those  which  are  delicate,  yet  do  not 
suffer  so  much  from  the  general  prostrating  effects  of  emetics,  especially 
the  more  active  ones.  In  the  exhibition,  therefore,  of  this  class  of 
agents,  due  allowance  must  be  made  for  this  circumstance.  Caeteris 
paribus,  fat  persons  are  vomited  with  more  facility  than  lean  ones. 
Hence,  when  there  is  great  wasting  of  the  body,  as  in  marasmus,  it  is 
frequently  impossible  to  excite  vomiting  at  all,  or,  if  excited,  it  is  per- 
formed with  great  pain  and  effort.  The  reason  is  obviously,  that  the 
volume  of  the  abdominal  organs  is  so  diminished,  that  they  cannot 
make  sufficient  pressure  upon  the  stomach  to  enable  the  process  of 
vomiting  to  be  performed. 

(d.)  Mode  of  Life  and  Climate. — These  have  a  very  powerful  influ- 
ence in  modifying  the  effects  of  emetics,  as  well  as  of  other  remedies. 
The  general  susceptibility  of  the  system  and  the  delicacy  of  the  tissues, 
it  is  well  known,  depend  very  materially  upon  the  occupation,  dress, 
exposure  to  the  atmosphere,  food,  &c.  Now  the  stomach  participates 
in  this  effort  as  much  as  any  other  part  of  the  system,  and  accordingly 
those  accustomed  to  laborious  employments  and  a  hard  diet,  and  at  the 
same  time  exposed  to  the  invigorating  influence  of  country  air,  require 
much  more  powerful  agents  to  excite  their  stomachs  than  those  living 
in  ease  and  luxury,  and  subjected  to  all  the  enervating  influences  of  a 
city  life.  The  learned  Zimmerman  remarks,  that  "  Boerhaave  pre- 
scribed emetics,  in  Holland,  which  would  have  been  too  powerful  for 
persons  whose  stomachs  were  not  loaded  with  cheese,  butter,  and  putrid 
fish.  The  people  at  Rome  eat  less  than  at  Paris,  and  therefore  they 
require  vomits  that  are  less  active"* 

Dr.  Brown,  of  Newburgh,  New  York,  informed  me  that  he  had 
noticed  a  marked  difference  in  the  effects  of  emetics  in  the  country  and 
in  the  city;  much  larger  doses  of  tartar  emetic  are  required  in  the 
country.     [Is  not  this  dependent  on  the  impurity  of  the  drug  I — Ed.] 

*  A  Treatise  on  Experience  in  Physic.  By  John  J.  Zimmerman,  M.D.,  vol.  i. 
p.  51. 

5 


60  MATERIA   MEDICA   AND   THERAPEUTICS. 

Besides  these  general  causes  connected  with  the  mode  of  life,  there 
are  others  of  a  more  special  character,  which  exert  a  striking  influence 
over  the  effects  of  the  more  active  emetics.  In  persons  whose  nervous 
systems  are  undermined  by  excessive  study,  or  more  particularly  by 
intemperance,  tartar  emetic,  for  example,  will  frequently  produce  the 
most  dangerous  results. 

(e.)  Frequent  Repetition. — The  general  law  of  the  system  in  relation 
to  medicinal  impressions  is,  they  become  less  and  less  in  proportion  as 
they  are  repeated.  Accordingly,  larger  doses  are  required  to  produce 
the  same  effect.  This  is  notoriously  the  case  with  stimulants  and  nar- 
cotics. To  this  general  law  emetics  form  an  exception.  So  far  from 
becoming  habituated  to  their  use,  the  stomach  becomes  more  and  more 
irritable  in  proportion  to  the  frequency  of  their  repetition.  Dr.  Cullen 
states  that  he  knew  persons  who  had  been  so  accustomed  to  excite 
vomiting  in  themselves,  that  the  twentieth  part  of  a  grain  of  tartar 
emetic  was  sufficient  to  excite  a  convulsive  action  of  the  stomach.* 

(/.)  Actual  Condition  of  the  System,  at  the  time. — Of  all  the  circum- 
stances modifying  the  effects  of  emetics,  this  is  the  most  important. 
The  states  of  the  system  more  particularly  influencing  the  action  of 
these  agents,  are  an  irritated  or  inflamed  state  of  the  stomach,  and  dis- 
order of  the  brain  and  nervous  system.  When  active  irritation  of  the 
-stomach  exists,  emetics  invariably  bring  on  painful,  if  not  ungovernable, 
vomiting  ;  a  striking  illustration  of  this  we  have  in  the  gastritis  which 
attends  yellow  fever. 

In  certain  disordered  conditions  of  the  Brain  and  Nervous  System, 
the  stomach,  instead  of  having  an  increased  sensibility,  can  with  diffi- 
culty be  roused  by  the  most  powerful  emetics.  Striking  illustrations  of 
this  are  met  with  in  apoplexy,  and  in  cases  where  the  system  is  laboring 
under  the  effects  of  opium  and  other  narcotics.  Maniacs,  it  has  long 
been  known,  are  peculiarly  unsusceptible  to  the  impression  of  ordinary 
emetics:;  so  much  so,  that  the  milder  emetics  frequently  produce  no  effect 
at  all,  even  though  given  in  very  large  doses  and  frequently  repeated. 
Ipecacuanha,  for  instance,  frequently  fails  altogether  in  producing  emesis 
under  these  circumstances,  and  the  only  one  which  is  efficacious  is  tar- 
tarized  antimony.  This  insensibility  to  the  impression  of  emetics  is 
particularly  observable  in  old  and  chronic  cases,  and  where  a  good  deal 
of  cerebral  congestion  is  present. 

Where  no  cerebral  congestion  or  inflammatory  action  is  present,  the 
insane  do  not  bear  well  the  operation  of  powerful  emetics.  Dr.  Ferriar 
states  that  he  has  seen  a  dangerous  debility  induced  by  the  action  of  a 
single  dose  of  tartar  emetic  operating  as  an  emetic.f 

In  cases  of  apoplexy,  too,  the  stomach  resists  in  a  remarkable  degree 

*  Richrand's  Physiology,  Note,  p.  29.        f  Histories,  &c,  p.  101. 


emetics.  61 

the  operations  of  emetics.  Under  these  circumstances,  it,  is  exceedingly 
difficult,  and  sometimes  impossible,  to  excite  vomiting.  Cloquet  relab 
tlie  case  of  a  person  laboring  under  apoplexy,  who  received  into  Ins 
Stomach  upwards  of  forty  grains  of  tartar  emetic,  without  producing 
either  nausea  or  vomiting.  On  dissection,  besides  the  morbid  state  of 
the  brain,  extensive  lesions  were  found  in  the  alimentary  canal,  which 
were  attributed  to  the  action  of  the  tartar  emetic*  Dr.  Harrison  relates 
a  case  of  a  patient  laboring  under  epilepsy,  to  whom  a  large  dose  of 
sulphate  of  zinc  was  given  unsuccessfully  in  producing  vomiting,  who 
died  from  the  effects  of  the  inflammation  which  it  caused  in  the  stomach.f 
These  cases  illustrate  very  strikingly  the  rashness  and  folly  of  striving 
to  secure  the  operation  of  a  medicine  by  increasing  inordinately  the 
dose,  when  the  difficulty  is  in  the  state  of  the  system.  In  cases  where 
the  system  is  under  the  influence  of  opium,  or  some  other  narcotic,  the 
same  difficulty  of  causing  vomiting  exists.  This  is  continual!)'  seen  in 
cases  of  poisoning  by  opium. 

Fourteen  grains  of  tartar  emetic  have  been  given  to  a  person  laboring 
under  the  stupor  produced  by  an  overdose  of  atropa  belladonna,  without 
causing  vomiting. 

The  explanation  of  these  facts  is  perfectly  simple,  if  we  recollect  the 
manner  in  which  vomiting  is  produced.  As  already  explained,  vomiting 
depends  upon  muscular  contraction,  and  cannot  take  place  without  it, 
no  matter  how  much  the  stomach  itself  may  be  stimulated.  Now,  the 
actions  of  the  muscles  depend  on  the  influence  which  they  derive  from 
the  brain  and  spinal  marrow.  When  the  brain  and  spinal  marrow 
become  paralysed  from  any  such  cause  as  apoplexy,  an  overdose  of 
opium,  and  the  like,  the  actions  of  the  muscles  cannot  be  exerted,  and 
vomiting  cannot  take  place.  At  the  same  time,  the  sensibility  of  the 
stomach  may  be  so  far  preserved  as  to  suffer  all  the  consequences 
resulting  from  too  large  closes  of  the  emetic,  acting  as  a  mere  local 
irritant.  In  this  way  it  happened  in  some  of  the  cases  just  noticed ; 
vomiting  could  not  be  induced,  yet  local  inflammation  ensued  sufficient 
to  destroy  life. 


STATES    OF    THE    SYSTEM     FAVORABLE    AND    UNFAVORABLE    TO    THE     EXHI- 
BITION   OF    EMETICS. 

As  emetics  produce  very  powerful  effects,  it  is  evident  that  they  ought 
to  be  used  with  caution.  It  is  important,  therefore,  to  designate  the 
particular  conditions  of  the  system  in  which  they  may  or  may  not  be 
used  with  safety. 


*  Paris  &  Fonblanque's  Medical  Jurisprudence,  v.  ii.  p.  280. 
f  Paris's  Pharroacologia,  p.  ST. 


62  MATERIA   MEDICA    AND   THERAPEUTICS. 

1.  Whenever  general  plethora  exists,  emetics  cannot  be  used  with 
safety.  The  reason  is  obvious.  During  the  convulsive  operation  of 
vomiting,  congestions  of  blood  about  the  head  always  take  place.  In 
the  ordinary  healthy  condition  of  the  vascular  system,  this  is  attended 
with  no  dangerous  consequences.  As  soon  as  the  vomiting  is  finished, 
an  equal  distribution  of  the  blood  throughout  the  body  takes  place.  But 
when  the  blood-vessels  are  unusually  distended,  these  congestions  during 
the  act  of  vomiting  have  been  known  to  terminate  in  apoplexy,  and  thus 
prove  fatal.  In  this  state  of  the  system,  therefore,  emetics  ought  never 
to  be  administered. 

2.  Whenever  great  determinations  to  the  brain  already  exist,  emetics 
should  be  avoided,  and  for  the  same  reason. 

3.  Whenever  any  organic  derangement  of  the  vascular  system  exists, 
emetics  are  dangerous  remedies.  In  organic  diseases  of  the  heart,  aneu- 
risms, &c,  they  are  never  to  be  used.  The  reason  is  plain.  During  the 
act  of  vomiting,  independently  of  the  general  agitation  of  the  system, 
there  is  a  violent  convulsion  of  the  whole  vascular  system — a  rapid 
ebbing  and  flowing  of  the  blood.  Now,  to  sustain  this  commotion,  it  is 
requisite  that  the  heart  and  blood-vessels  should  be  in  a  healthy  state. 
Any  portion  of  them  that  may  be  enfeebled  by  organic  disease  is  liable 
to  rupture,  which  must  prove  fatal. 

4.  Whenever  any  great  contraction  of  the  muscles  concerned  in  vomit- 
ing may  prove  injurious,  emetics  ought  not  to  be  used.  Hernia,  pregnancy, 
prolapsus  uteri,  &c,  may  be  mentioned  as  illustrations.  In  all  these 
cases,  the  pressure  of  the  diaphragm  and  abdominal  muscles  upon  the 
viscera  of  the  abdomen  during  the  act  of  vomiting  does  mischief.  In 
hernia,  it  causes  the  still  greater  protrusion  of  the  viscera,  and  in  some 
cases  may  cause  strangulation  of  it.  In  pregnancy,  as  before  stated,  the 
act  of  vomiting  may  bring  on  premature  contractions  of  the  uterus  and 
thus  cause  miscarriage.  This  is  particularly  the  case  in  advanced  stages 
of  pregnancy,  and  in  those  who  have  had  previous  miscarriages. 

5.  Whenever  the  mucous  membrane  of  the  stomach  is  in  a  state  of  in- 
flammation, emetics  are  improper.  Under  these  circumstances,  they 
have  the  effect  of  adding  to  the  irritation  of  the  stomach,  and  keeping 
up  protracted  and  frequently  ungovernable  vomiting. 

6.  Whenever  a  state  of  extreme  debility  is  present,  emetics  are  not  to 
be  used.  The  agitation  occasioned  during  the  paroxysm  of  vomiting, 
and  the  relaxation  and  prostration  consequent  upon  this  process,  may 
prove  exceedingly  injurious,  and  in  some  cases  even  fatal.  [Capillary 
bronchitis  forms  an  exception  to  this  rule,  and  I  think  there  are  others.] 

Having  thus  pointed  out  the  conditions  of  the  system  in  which  this 
class  of  remedies  ought  not  to  be  used,  there  is  no  difficulty  in  defining 
the  state  of  the  system  in  which  they  may  be  safely  resorted  to,  provided 
their  use  be  indicated.    If  the  organs  of  circulation  be  in  a  sound  state — 


EMETICS.  »v{ 

if  the  blood-vessels  be  not  too  full — if  there  he  no  determination  oj  blood 
to  the  head — if  the  system  be  in  such,  a  stale  as  to  bear  muscular  convul 
sion  without  danger — if  there  be  no  active  irritation  of  the  stomach,  and 
if  there  be  a  due  degree  of  strength,  then  these  remedies  ma)'  be  safelj 
used, 

MODES    OF    ADMINISTERING    EMETICS. 

1-  By  the  stomach,  the  almost  universal  mode,  to  which,  however, 
there  are  exceptions,  when  we  resort 

2.  To  the  skin.  Emetic  substances  can  be  made  to  operate  through 
the  skin  cither  by  the  Iatroleptic  or  Endermic  method. 

The  vegetable  emetics  can  be  safely  used  in  both  these  ways ;  but 
tartar  emetic  should  never  fee  used  in  either,  on  account  of  the  very 
severe  local  irritation  which  it  produces.  Used  cndermically,  it  has 
produced  gangrene  of  all  the  tissues  of  the  skin,  and  that  without  in- 
ducing vomiting. 

3.  Injection  into  the  veins.  This,  as  before  remarked,  is  attended 
with  so  much  danger  that  its  use  is  only  justifiable  in  the  most 
extreme  circumstances,  as  where  a  patient  is  choking  from  food  in 
the  oesophagus,  <fcc.,  &c.  Under  such  circumstances  vomiting  has  been 
induced  and  life  saved  by  injecting  tartar  emetic  into  the  veins. 

RULES    TO    BE  OBSERVED    IN    THE    ADMINISTRATION  OF    EMETICS. 

1.  As  a  general  rule,  unless  where  the  object  is  simply  to  evacuate 
the  stomach,  emetics  should  be  taken  fasting.  Hence  the  best  periods 
for  their  administration  are  early  in  the  morning  or  late  at  night.  In 
this  condition  of  the  stomach  they  act  with  greater  certainty,  from  the 
fact,  probably,  of  their  coming  in  a  more  unmixed  state  in  contact  with 
the  inner  surface  of  that  organ,  and  thus  being  more  certainly  and 
speedily  absorbed.  It  is  not  to  be  understood  from  this,  however,  that 
the  mechanical  act  of  vomiting  takes  place  with  greater  ease  when  the 
stomach  is  perfectly  empty.  On  the  contrary,  from  what  has  been 
already  stated  in  relation  to  this  process,  it  is  evident  that  a  certain 
degree  of  distension  of  the  stomach  must  greatly  facilitate  the  act  of 
vomiting.  This  is  a  fact  which  has  long  been  known  and  practised 
upon,  although  the  reason  of  it  may  not  have  been  understood.  It  was 
on  this  account  that  the  ancients  were  in  the  habit  of  filling  the  stomach 
with  food  previously  to  vomiting,  to  assist  the  process.  This,  however, 
is  objectionable  on  a  variety  of  accounts.  It  loads  the  stomach  for  an 
unnecessary  length  of  time,  while  it  interferes  with  the  action  of  the 
emetic  substance  upon  it.  The  best  plan  is  the  one  in  common  use 
with  practitioners,  viz.  make  the  patient  drink  as  freely  as  possible  of 


64  MATERIA   MEDICA   AND   THERAPEUTICS. 

some  mild  diluent  drink  as  soon  as  the  emetic  begins  to  operate  ;  diluents 
should  not  be  taken  till  after  one  free  emesis,  as  they  hurry  on  the  vomit- 
ing, and  it  is  partial.     The  best  is  chamomile  tea. 

2.  As  it  is  not  safe  to  vomit  in  all  conditions  of  the  system,  attend 
to  this,  especially  to  the  blood-vessels.  If  your  patient  be  plethoric, 
bleed  first.  It  will  prevent  dangerous  congestion  of  the  brain,  and  at 
the  same  time  secure  more  effectually  the  general  relaxing  effects. 

3.  As  a  general  rule,,  keep  your  patient  in  bed.  This  is  especially 
necessary  where  you  wish  the  general  effects  of  the  remedy. 

4.  The  temperature  of  the  room  should  be  attended  to.  Never  give 
an  emetic  either  in  a  very  hot  or  very  cold  room. 

5.  Make  up  your  mind  beforehand  as  to  the  precise  object  you  have  in 
view  in  giving  the  remedy.  Is  it  merely  to  evacuate  the  stomach,  or  do 
you  desire  to  affect  the  system  at  large  ?  Select  your  emetic  according 
as  you  desire  to  fulfil  the  one  or  the  other  indication. 

6.  In  judging  of  the  general  effects  of  the  remedy,  do  not  refer 
to  the  amount  vomited,  but  rather  to  the  influence  produced  on  the 
system. 

7.  It  is  most  prudent  to  give  emetics  in  divided  doses,  and  continue 
the  administration  till  the  result  is  satisfactory. 

8.  Never  give  an  emetic  unless  you  are  perfectly  clear  that  it  is 
necessary.  Would  that  this  last  caution,  in  its  application  to  all  the 
active  articles  of  the  Materia  Medica,  could  be  impressed  on  the  minds 
of  all  practitioners  f 

In  relation  to  the  effects  of  emetics,  there  are  one  or  two  other  things 
to  be  noticed  a  little  particularly  :  1st,  the  mechanism  of  vomiting;  2d, 
the  character  of  the  discharges  from  the  stomach. 

1.  The  Mechanism,  of  Vomiting. — On  this  subject  three  opinions  have 
been  advanced.  First,  That  emesis  was  produced  by  the  stomach  alone. 
Second,  That  It  resulted  from  the  action  of  the  diaphragm  and  abdomi- 
nal muscles  alone,  the  stomach  being  passive.  Third,  That  it  was  the 
effect  of  the  joint  action  of  both  the  stomach  and  the  abdominal  muscles. 

The  two  former  opinions  are  now  quite  generally  abandoned,  and  all 
agree  that  emesis  is  the  result  of  the  joint  action  of  the  stomach,  the 
diaphragm,  and  the  abdominal  muscles. 

2.  Of  the  matters  discharged  hy  Vomiting. — As  there  are  different 
organs  called  into  action  by  emetics,  and  as  the  secretions  from  these 
organs  differ,  so  the  discharges  caused  by  the  operation  of  this  class  of 
agents  vary  in  their  character.  An  acquaintance  with  these  is  impor- 
tant, inasmuch  as  it  is  only  in  this  way  that  it  can  be  ascertained  to 
what  extent  the  emetic  has  produced  its  effect. 

"When  an  emetic  begins  to  operate,  the  first  discharges  consist  of 
whatever  matters  may  be  found  in  the  stomach.  After  this,  fluids  of 
various  kinds  are  brought  up  according  to  the  organs  specially  acted  on. 


KMKTICS.  65 

Sometimes  tlic  matter  evacuated  is  entirely  serous  or  aqueous,  show- 
ing an  increased  exhalation  from  the  vessels  of  the  stomach. 

Sometimes  it  is  a  viscid  mucus.  This  shows  that  the  mucous  follicles 
of  these  organs  have  been  excited  into  action.  Either  of  these  dis- 
charges may  take  place  in  very  great  quantity. 

At  other  times  the  matter  discharged  is  bilious — sometimes  almost 
pure  bile,  but  generally  mixed  with  other  fluids.  In  some  cases  the 
bile  thus  discharged  may  be  nothing  more  than  what  is  continually 
passing  into  the  duodenum  from  the  ducts  ;  while  in  other  cases  there 
is  an  increased  action  in  the  liver  itself,  and  an  increased  evacuation 
from  the  gall-bladder.  That  bile  is  actually  secreted  in  greater  quantity 
than  natural  during  the  operation  of  emetics,  is  evident  from  the 
quantity  which  is  sometimes  discharged  being  altogether  greater  than 
what  is  contained  in  the  gall-bladder. 

It  has  been  supposed  that  the  bile  discharged  by  vomiting  existed, 
previously  in  the  stomach  itself.  In  some  cases  this  is  very  possible. 
Generally,  however,  it  appears  to  be  brought  into  the  stomach  during 
the  process  of  vomiting.  What  proves  this  conclusively  is  that  the 
bile  does  not  appear  in  the  first  discharges,  but  only  after  repeated 
vomitings. 

As  a  general  rule,  when  a  person  vomits  speedily  after  taking  an 
emetic,  there  is  no  bile  discharged.  This  is  owing  to  the  impression 
of  the  emetic  substance  not  having  extended  itself  to  the  liver. 

The  matters  just  noticed  as  being  ejected  in  consequence  of  the  use 
of  emetics,  are  those  which  are  seen  in  the  healthy  state  of  the  stomach 
and  the  other  organ?.  In  morbid  conditions  of  these  organs  a  great 
variety  of  other  fluids  is  thrown  up.  Sometimes  they  are  black, 
resembling  coffee-grounds,  at  other  times  resembling  the  yolk  of  eggs. 
These  are  all  extravasated  blood  or  morbid  secretions. 

Before  proceeding  to  the  subject  of  the  application  of  emetics  to  the 
cure  of  disease,  I  desire  to  say  a  few  words  on  the  various  indications  they 
are  competent  to  fulfil  and  the  various  ways  in  which  they  prove  curative. 

1.  Indications  to  be  fulfilled  by  an  Emetic. — These  are — 

((/.)  The  simple  evacuation  of  the  stomach — this  is  all  we  require  in 
cases  of  overloaded  stomach  and  of  poisoning ;  the  three  qualities  in 
any  emetic  substance  which  fit  it  for  use  under  these  circumstances 
are,  that  it  should  act  promptly,  with  as  little  nausea  as  possible,  and 
should  leave  behind  but  little  prostration. 

(b.)  Emetics  may  be  required  to  make  an  impression  on  the  mucous 
membrane  of  the  stomach  and  change  its  morbid  condition,  hence  their 
use  in  dyspepsia.     Ipecacuanha  best  fulfils  this  indication. 

(c.)  Emetics  may  be  given  to  evacuajte  the  trachea  and  bronchi,  as  in 
croup,  bronchitis,  &c. 

(d.)  They  are  sometimes  used  to  obviate  the  habit  of  constipation. 


66  MATERIA   MEDICA    AND   THERAPEUTICS. 

(e.)  By  the  shock   the)'  produce    on    the  whole    system  they   may- 
interrupt  paroxysmal  diseases,  as  intermittent  fevers. 
^yT)~TEey  relieve    congestions,  especially   of  the  abdominal  viscera, 
hence  their  use  in  some  forms  of  fever  attended  by  congested  liver. 

((/.)  They  produce  general  relaxing  and  debilitating  effects  on  the 
system  at  large,  lessen  the  action  of  the  heart  and  arteries,  promote 
respiration,  and  unlock  the  secretions  generally.  When  this  relaxation 
is  extreme,  as  it  often  is  where  excessive  nausea  precedes  the  operation 
of  the  emetic,  the  muscles  are  rendered  powerless,  and  hence  the 
nauseating  emetics  are  often  used  by  surgeons  to  prepare  the  way  for 
mechanical  efforts  to  reduce  luxations  and  return  hernial  tumors. 

(A.)  They  promote  absorption,  and  thus  do  good  in  hernia  humora- 
lis,  <fec. 

Either  of  these  indications  emetics  may  fulfil ;  only  be  careful  in 
their  use  to  make  up  your  mind  decidedly  which  of  these  indications 
you  desire,  else  will  your  practice  be  always  empirical  and  uncertain. 

Application  of  Emetics  in  the  treatment  of  Diseases.— In  treat- 
ing of  this  part  of  the  subject  it  is  not  my  intention  to  notice  every 
individual  disease  in  which  this  class  of  medicines  may  be  used.  To 
do  this  would  of  itself  occupy  a  volume.  I  shall  only  mention  some  of 
the  more  important  classes  of  disease,  with  a  view  of  illustrating  not 
merely  the  effects  of  emetics,  but  also  the  general  principles  which  have 
been  laid  down  concerning  their  use. 

I.  Fevers. — In  no  class  of  diseases  perhaps  have  emetics  been  more 
generally  or  extensively  used  than  in  fevers.  In  every  age  and  country, 
and  in  every  form  and  variety  of  fever,  they  have  been  prescribed. 
Notwithstanding  this,  they  are  not  remedies  which  can  or  ought  to  be 
used  indiscriminately,  and  it  depends  entirely  upon  the  character  of  the 
fever  and  the  particular  period  at  which  they  may  be  given,  whether 
their  exhibition  will  be  attended  by  beneficial  or  injurious  consequences. 
The  general  principles  upon  which  they  may  be  rendered  available 
are  obvious  enough,  and  they  are  given  with  the  twofold  view  ot 
obtaining  the  local  effects  which  they  produce  upon  the  stomach  and 
biliary  organs,  and  the  general  effects  on  the  circulation  and  the  system 
at  large.  The  general  objects  then  for  which  emetics  may  be  advan- 
tageously given  in  fevers,  are  the  following : — 

1.  To  evacuate  the  stomach  and  make  an  impression  on  its  mucous 
membrane. 

2.  To  excite  the  secretions  of  the  liver. 

3.  To  give  a  general  shock  to  the  nervous  system. 

4.  To  equalize  the  circulation. 

5.  To  relax  the  surface. 

Of  these  the   two  first  are  the    essential    indications  to  be  fulfilled. 


EMETICS.  07 

TIic  three  last  are  mere  consequences  of  the  others,  and  can  frequently 
be  better  accomplished  by  other  menus.  As  a  general  rule,  therefore, 
whenever  it  is  desirable  to  make  an  impression  upon  the  mucous  mem- 
brane of  the  stomach,  and  to  excite  the  biliary  organs  to  Becretion, 
emetics  may  be  used  with  advantage.  The  preliminary  question  then  to  I"; 
settled  is,  what  is  the  precise  condition  of  the  stomach  and  biliary  organs 
which  requires  and  will  admit  of  this  impression  being  made  upon  them  ? 
The  answer  to  this  is  evident.  If  the  symptoms  of  the  fever  indicate 
nothing  more  than  afunctional  derangement  of  the  stomach  and  liver, 
emetics  may  be  given  with  safety,  and  frequently  with  general  benefit. 
They  clear  the  stomach  of  vitiated  secretions,  excite  a  new  action  in 
the  mucous  membrane,  and  promote  healthy  secretions  from  it. 
Extending  their  action,  they  excite  the  torpid  liver  and  cause  a  copious 
secretion  of  bile,  and  thus  relieve  a  congested  state  of  that  organ.  If, 
on  the  other  band,  however,  there  should  be  present  an  active  irritation 
or  inflammation  of  the  mucous  membrane  of  the  stomach  or  duodenum, 
emetics  do  harm.  They  excite  painful  vomitings,  increase  the  irrita- 
bility of  the  stomach,  and  aggravate  the  local  inflammation.  As  fevers 
differ,  however,  greatly  in  their  character  and  in  different  periods  of 
the  disease,  and  as  the  use  of  remedies  must  be  modified  accordingly,  it 
will  be  necessary  to  notice  the  principal  varieties  of  fever  a  little  in  detail. 

(a.)  Intermittent  Fever. — From  the  earliest  periods  emetics  have  been 
resorted  to  in  this  form  of  fever.  Galen  and  Celsus  both  speak  of  them 
as  necessary  to  the  cure,  and  since  then  they  have  been  in  common  use 
with  physicians  in  every  part  of  the  world.  Their  use,  therefore,  is 
sanctioned  by  long  experience  and  concurring  testimony. 

The  period  best  suited  for  giving  emetics  is  in  the  intermission,  and 
just  before  the  return  of  a  paroxysm.  This  was  the  practice  recom- 
mended by  Sydenham.  He  says,  if  given  just  "before  the  paroxysm  is 
expected,  so  that  the  operation  of  it  may  be  completely  over  before  the 
time  of  the  paroxysm,  it  frequently  puts  a  stop  to  it,  and  especially,  he 
adds,  if  an  opiate  be  given  after  the  operation  of  the  emetic  is  com- 
pleted.* And  the  best  articles  that  can  be  selected  are  ipecacuanha 
and  tartar  emetic  combined  in  the  proportion  of  about  grs.  xv.  of  the 
former  and  grs.  ij.  of  the  latter.  In  a  majority  of  cases,  however,  eme- 
tics are  by  no  means  necessary,  and  every  beneficial  and  desirable  effect 
upon  the  stomach  and  liver  can  be  obtained  by  the  milder  operation  of 
a  suitable  cathartic.  In  some  cases,  the  revolutionary  impression  of  an 
emetic  is  absolutely  essential  before  any  progress  can  be  made  in 
effecting  a  cure.  It  seems  not  merely  to  break  in  upon  the  periodical 
character  of  the  disease,  but  to  prepare  the  system  for  the  efficient 
operation  of  other  remedies. 

*  The  "Works  of  Thomas  Sydenham,  M.D.,  with  Notes  by  Benjamin  Rush,  M.D., 
pp.  37,  420. 


68  MATERIA   MEDICA   AND   THERAPEUTICS. 

Before  leaving  the  subject  of  intermittent  fever,  I  cannot  refrain  from 
making  a  remark  in  relation  to  the  practice  of  repeating  emetic8  every 
few  days,  in  case  the  fever  proves  obstinate.  No  possible  good,  but 
much  positive  harm,  may  result  from  such  practice.  All  the  beneficial 
effects  to  be  expected  from  emetics  can  be  gained  from  using  them 
once  or  twice. 

(b.)  Remittent  Fever. — This  disease  presents  itself  in  two  different 
forms,  viz.  that  of  the  simple  remittent  and  the  bilious  remittent.  The 
latter  is  the  form  of  fever  prevalent  in  hot  climates,  and  in  the  hot  sea- 
sons at  the  South  and  West  in  this  country.  It  is  acute  in  its  charac- 
ter, and  frequently  terminates  fatally  on  the  third  or  fifth  day.  Com- 
pared with  this  the  former  is  a  mild  disease.  In  both  the  varieties  of 
remittent  fever,  certain  symptoms  are  present  which  would  seem  to 
indicate  the  propriety  of  emesis — loaded  tongue — disorder  of  the  sto- 
mach— nausea  and  sometimes  actual  vomiting — together  with  a  de- 
ranged state  of  the  liver;  it  is  for  the  correction  of  these  symptoms 
that  emetics  have  been  so  generally  recommended.  Plausible  as  the 
practice  appears,  experience  has  abundantly  shown  that  it  is  liable  to 
numerous  exceptions.  In  the  simple  remittent  there  is  no  question  but 
they  are  frequently  remedies  of  value,  and  from  the  general  mildness  of 
the  symptoms  their  use  is  attended  with  no  danger.  The  best  period 
for  their  use  is  the  early  stage  of  the  disease,  and  they  then  serve  as 
valuable  preliminary  means  to  prepare  the  system  for  the  subsequent 
action  of  other  means.  They  are  by  no  means  essential'  remedies,  and 
their  beneficial  effects  upon  the  stomach  and  liver  may  be  obtained  by 
other  means.  In  some  cases,  too,  they  are  decidedly  objectionable,  and 
especially  when  the  irritability  of  the  stomach  is  associated  with  any- 
thing like  active  inflammation  of  the  mucous  membrane  of  this  organ. 
They  then  only  serve  to  aggravate  this  inflammation  and  operate 
injuriously. 

In  the  Bilious  remittent  of  hot  climates  and  seasons,  the  objections 
to  the  use  of  emetics  are  still  more  cogent.  One  of  the  prominent 
symptoms  here  is  acute  irritation  of  the  stomachj  and  the  effect  of 
emetics  is  to  increase  this  irritation  and  bring  on  irrestrainable  vomit- 
ing. Dr.  Cooke,  of  Lexington,  in  speaking  of  the  use  of  emetics  in  our 
southern  fevers,  says  that  "  although  safe  and  useful  in  common  fevers, 
in  seasons  in  which  the  cause  (of  fever)  is  abundant  and  active,  pro- 
ducing extensive  sickness,  the  stomach  is  often  so  irritable  that  the 
vomiting  cannot  be  stopped.  In  1804  and  1823,  many  lives  were  lost, 
manifestly  from  the  violence  of  their  operation."* 

Yelloiv  Fever. — In  this  form  of  fever,  emetics,  although  recommended 
by  some,  cannot,  as  a  general  rule,  be   used  with  safety.     Whatever 

*  Medical  Eecorder,  vol.  vii.  p.  512. 


EMETICS.  69 

may  be  tlie  theoretical  notions  entertained  in  relation  to  this  disease, 
one  thing  is  established  both  by  the  symptoms  and  by  the  die  ection, 
and  this  is,  that  the  stomach  is  the  seat  of  acute  inflammation.  It  is 
this  which  gives  rise  to  that  terrible  symptom,  blaci  vomit,  which 
generally  terminates  only  with  the  life  of  the  patient.  If  this  be  so,  we 
should  naturally  infer  that  emetics  would  hurry  on  and  aggravate  this 
symptom ;  and  such  is  proved  to  be  the  fact  by  experience,  both  in  the 
West  Indies  and  in  this  country. 

(c.)  Continued  Fevers. — After  what  has  been  said  in  relation  to  the 
use  of  emetics  in  intermittent  and  remittent  fevers,  a  few  words  will 
suffice  in  relation  to  their  use  in  the  continued  forms  of  fever;  as 
occasional  remedies,  and  with  due  regard  to  the  existing  condition  of  the 
system,  they  may  be  used  in  all  of  them.  The  propriety  of  having 
recourse  to  them  must  be  decided  by  the  stage  of  the  fever,  the  condition 
of  the  vascular  system,  the  presence  or  absence  of  local  inflammation  or 
congestion,  and  the  state  of  the  stomach.  [Emetics  have  almost  entirely 
gone  out  of  fashion  in  the  treatment  of  fever.  They  are  now  used  only 
in  those  exceptional  cases  where  a  loaded  tongue,  foul  breath,  and  nausea, 
clearly  indicate  an  overloaded  stomach  as  an  aggravating  cause.  In 
such  cases  ipecac,  is  sometimes  given  ;  tartar  emetic  almost  never.] 

II.  Inflammations. — For  the  purpose  of  determining  the  use  and  value 
of  emetics  in  this  form  of  disease,  it  will  be  necessary  to  keep  in  view 
the  general  object  to  be  attained  in  the  management  of  inflammation. 
This,  of  course,  is  to  relieve  the  local  embarrassment,  and  to  lessen  the 
general  excitement  which  accompanies  it.  Whether  emetics,  then, 
co-operate  in  fulfilling  this  indication,  is  the  problem  to  be  solved. 
From  what  has  previously  been  stated  in  relation  to  the  changes  which 
take  place  in  the  system  during  the  process  of  vomiting,  it  is  evident 
that  the  mere  act  of  vomiting  can  be  of  no  service.  On  the  contrary, 
from  the  great  shock  given  to  the  system,  from  the  vascular  and  mus- 
cular agitation  which  it  causes,  it  may  have  the  effect  of  increasing  pain, 
and  still  further  crowding  the  inflamed  capillary  vessels,  besides  aug- 
menting the  general  inflammatory  fever.  The  mere  act  of  vomiting, 
then,  so  far  from  being  beneficial,  may  be  exceedingly  injurious. 

The  secondary  effects  of  emetics  are  of  a  different  character.  They 
relax  the  system,  equalize  the  circulation,  and  promote  the  various  secre- 
tions— all  favorable  and  important  in  the  resolution  of  inflammation.  If 
these  effects  could  be  secured,  without  the  disadvantages  of  the  first, 
there  could  be  no  question  as  to  their  utility.  The  circumstances  under 
which  they  may  be  resorted  to  are  the  following  : — 

1.  When  the  inflammation  is  moderate  in  degree.  As  a  general  rule, 
just  in  proportion  to  the  violence  of  the  inflammation  which  may  be 
present,  will  be  the  distress  attending  the  convulsive  operation  of  emetics, 
while  the  relaxing  effects  will  be  inconsiderable  and  inefficient.     T\  hen 


70  MATERIA    MEDICA    AND    THERAPEUTICS. 

the  inflammation  is  mild  in  its  character,  or  when  active  depletion  has 
been  premised,  emetics  may  frequently  be  used  with  benefit. 

2.  When  the  inflammation  is  seated  in  such  a  structure,  as  that  the 
operation  of  emetics  will  cause  copious  secretions  from  the  part,  as  it 
does  in  many  inflammations  of  the  mucous  membrane,  the  local  depletion 
which  they  cause,  together  with  their  general  effects  on  the  system,  not 
merely  counterbalance  all  the  objectionable  effects  attending  them,  but 
render  them  exceedingly  beneficial. 

3.  When  inflammation  is  complicated  with  functional  derangement 
of  the  stomach  and  biliary  organs.  In  cases  of  this  kind,  whatever  be 
the  seat  of  inflammation,  emetics  may  frequently  prove  useful  by 
correcting  the  condition  of  these  organs,  and  in  this  way  aid  in  simplify- 
ing the  character  of  the  disease. 

Diseases  of  the  Head. — From  the  effects  of  emetics  on  the  head  as 
already  detailed,  it  is  evident  that  they  are  remedies  which  must  be 
used  with  great  caution  in  diseases  of  this  part.  Although  valuable 
agents  in  some  cases,  they  frequently  are  not  merely  useless,  but  posi- 
tively injurious.  It  is  important,  therefore,  properly  to  discriminate 
between  these  cases.  In  all  active  inflammations  or  congestions  of  the 
brain,  as  a  general  rule,  they  ought  not  to  be  used.  In  the  treatment  of 
these  conditions  of  the  brain,  the  great  object  is  to  divert  the  flow  of 
blood  from  this  organ  by  every  means  in  our  power,  and  for  this  purpose 
we  have  recourse  to  all  those  agents  which  have  a  tendency  to  promote 
the  flow  of  blood  to  other  parts.  From  the  effects  of  emetics  in  accumu- 
lating blood  about  the  head,  it  is  evident  that  they  cannot  be  advisable 
in  cases  of  this  kind.  Indeed,  as  a  general  rule,  they  necessarily 
aggravate  the  existing  morbid  condition  of  the  brain.  With  regard  to 
the  use  of  emetics  in  apoplexy,  great  diversity  of  sentiment  has  existed. 
By  some  of  the  highest  authorities  in  medicine  they  have  been  decidedly 
recommended — Sydenham,  for  example,  advises  an  emetic  to  be  given 
immediately  after  bleeding  from  the  arm  and  jugular  veins.  Dr.  Fothei'- 
gill,  too,  recommends  them.  The  majority  of  physicians,  however,  are 
opposed  to  them,  and  I  think  that  there  can  be  no  question  that  they 
are  agents  which  must  generally  prove  injurious.  There  is  one  form  of 
apoplexy,  however,  in  which  they  may  be  used  with  advantage,  and 
that  is  when  the  apoplectic  seizure  is  occasioned  by  an  overloaded 
stomach,  as  it  sometimes  is.  In  cases  of  this  kind,  after  suitable  deple- 
tion, emetics  will  be  the  most  efficient  agents  in  affording  relief. 

Although,  therefore,  in  active  inflammation  and  congestion  of  the 
brain  emetics  are  doubtful,  yet  there  are  other  disordered  conditions  of 
this  organ,  in  which  they  have  been  found  exceedingly  useful — of  these 
mania  and  intermitting  headache  may  serve  as  illustrations. 

In  mania,  emetics  may  prove  salutary  in  several  ways.     In  the  first 


EMETICS.  1} 

place  in  many  cases  of  this  disease  there  is  present,  a  torpid  and  de- 
ranged condition  of  the  liver,  BtODiach,  and  bowels.  In  many  instances 
this  condition  is  associated  with  the  origin  of  the  malady,  while  in 
others  it  may  supervene  as  one  of  the  effects  of  the  primary  di  ea 
In  either  case  it  exercises  a  very  powerful  influence  over  the  general 
course  and  severity  of  the  disease.  To  correct  this  state  of  things  is 
accordingly  of  great  importance,  and  among  the  best  remedies  to  begin 
with  are  emetics.  By  the  impression  which  they  make  upon  the  mucous 
surfaces  of  the  stomach,  on  the  intestines,  and  the  liver,  and  hy  the 
secretions  which  they  cause  from  them,  they  relieve  the  congestion  not 
merely  of  these  hut  of  the  abdominal  viscera.  In  this  way  they  operate 
frequently  indirectly  in  quieting  the  cerebral  disturbance. 

In  the  second  place,  emetics  may  prove  beneficial  by  the  general 
relaxing  effects  which  they  produce — tranquillizing  the  vascular  system 
and  promoting  a  more  equal  distribution  of  the  blood. 

In  the  third  place,  emetics  sometimes  prove  salutary  by  the  general 
shock  which  they  give  to  the  brain  and  whole  nervous  system  during 
their  operation. 

In  either  of  these  ways,  or  by  the  combined  effect  of  the  whole,  this 
class  of  remedies  may  prove  in  many  cases  exceedingly  advantageous. 
In  using  them  of  course  you  are  to  bear  steadily  in  mind  the  general 
precautions  already  laid  down.  If  the  head  should  be  crowded  with 
blood,  or  if  there  should  be  great  general  plethora,  they  are  to  be  ab- 
stained from  until  this  is  corrected. 

[Emetics  are  not  as  much  used  now  as  formerly  in  mania,  and  ipecac, 
is,  I  think,  very  generally  preferred.] 

In  Hysteric  Convulsions,  emetics  are  frequently  the  most  efficient 
remedies  that  can  be  used,  generally  arresting  the  convulsions  as  soon 
as  free  vomiting  is  effected.  Should  the  patient  be  full-blooded,  or 
should  there  be  great  determination  to  the  head,  it  is  advisable  to  draw 
blood  from  the  arm.  Generally,  however,  amid  the  struggles  of  the 
patient,  this  is  a  difficult  operation,  and  the  cases  are  very  rare  indeed 
in  which  an  emetic  may  not  safely  be  given  at  once.  After  the  spasms 
are  quieted,  blood  may  then  be  drawn  to  an  extent  deemed  advisable  by 
the  circumstances  of  the  case. 

In  the  convulsions  to  which  children  are  subject,  emetics  are  no  less 
serviceable  than  in  those  of  which  I  have  just  spoken.  Of  course,  I  do 
not  now  allude  to  those  convulsions  which  arise  from  organic  affections 
of  the  brain,  such  as  hydrocephalus  and  the  like,  but  to  the  ordinary 
convulsions  to  which  children  are  so  liable,  and  which  usually  arise  from 
dentition  or  from  crude  accumulations  in  the  intestinal  canal.  In  both 
cases,  emetics  of  ipecacuanha  will  be  found  to  operate  with  great  efficacy 
in  arresting  the  convulsion. 

In  Epilepsy,  the  use  of  emetics  was  recommended  so  far  back  as  the 


72  MATERIA   MEDICA   AND   THERAPEUTICS. 

time  of  Aretseus.  The  practice,  however,  does  not  appear  to  have  been 
a  very  popular  one,  and  it  is  only  recently  that  it  has  been  revived.  The 
principal  causes  of  this  curious  disease  may  be  referred  to  two  general 
classes,  viz.  organic  affections  of  the  brain,  and  irritations  existing  in 
the  digestive  organs  acting  sympathetically  on  the  brain.  In  epilepsy 
arising  from  the  last  of  these  causes,  there  can  be  no  doubt  of  the  pro- 
priety of  the  use  of  emetics,  as  they  operate  directly  in  removing  the 
cause  of  the  disease.  Even  in  cases,  however,  where  epilepsy  arises 
from  some  disordered  condition  of  the  brain,  emetics  may  frequently  be 
used,  not  merely  with  safety,  but  advantage,  provided  great  fulness  of 
the  brain  be  not  present,  in  which  case  they  would  be  improper  until 
after  depletion.  In  young  patients  subject  to  this  disease,  the  use  of 
emetics  is  frequently  attended  with  the  happiest  effects.  Very  gene- 
rally, in  cases  of  this  kind,  occasional  sickness  at  the  stomach,  flatulency, 
and  other  evidences  of  a  deranged  condition  of  the  digestive  organs 
will  be  found ;  and  under  these  circumstances  an  emetic  of  ipecacuanha 
and  sulphate  of  zinc  combined,  repeated  every  three  or  four  days,  will 
be  found  a  remedy  of  great  value.  Although  not  tried,  so  far  as  my 
knowledge  extends,  I  would  suggest  whether  some  prospect  of  advan- 
tage is  not  held  out  by  the  use  of  emetics  in  those  hitherto  intractable 
diseases,  tetanus  and  hydrophobia.  The  article  which  should  be  pre- 
ferred in  these  cases  is  the  tartar  emetic,  as  most  likely  to  produce  a 
full  relaxing  and  antispasmodic  effect  on  the  system.  Many  headaches 
depend  upon  some  disordered  condition  of  the  digestive  organs,  and 
may  be  relieved  by  the  use  of  emetics.  In  that  species  of  it  which  is 
called  intermitting,  they  will  be  found  pre-eminently  beneficial.  This 
disease  appears  to  be  an  intermittent  in  disguise,  and  requires  to  be 
treated  upon  precisely  the  same  principles.  In  some  cases,  it  may  be 
cured  by  the  simple  use  of  antiperiodics,  used  as  in  intermittents. 
Cases,  however,  occur  in  which  this  does  not  answer  until  a  full 
emetic  has  been  given.  It  operates  by  two  ways — by  correcting 
any  latent  disorder  of  the  digestive  organs,  and  by  giving  a  shock 
to  the  nervous  system,  by  which  the  recurring  morbid  action  is  ob- 
viated. 

Diseases  of  the  Throat  and  Chest. — In  a  great  number  of  these  affec- 
tions, emetics  are  remedies  of  inestimable  value,  and  they  operate  bene- 
ficially in  the  following  ways.  1.  By  promoting  the  secretions  of  the 
mucous  membrane  of  the  larynx,  trachea,  and  lungs.  2.  By  aiding  ex- 
pectoration.    3.  By  their  general  relaxing  effects  on  the  system. 

In  Tonsilitis,  an  emetic  of  tartarized  antimony  and  ipecacuanha  may 
frequently  be  given  with  great  advantage.  Where  the  patient  is  ple- 
thoric suitable  depletion  should  be  premised.  In  many  cases  every 
advantage  may  be  obtained  by  putting  the  patient  on  a  solution  of  tar- 


EMETICS.  73 

tar  emetic  with  tlic  view  of  causing  Dausea,  without  carrying  it  to  Che 
extent  of  actual  vomiting. 

In  Cynanche  Maligna,  if  given  sufficiently  early  in  the  disea  e,  they 
are  remedies  much  to  be  relied  on,     They  dislodge  the  morbid  Becre- 

tions  accumulated  about  the  fauces,  change  the  action  of  the  part,  and 
have  a  tendency  to  restore  the  natural  secretions.  From  the  great  illus- 
tration which  ensues  in  this  disease,  they  are  remedies  which  should  be 
used  with  caution.  In  the  advanced  periods  of  it,  emetics,  if  used  at 
all,  should  never  be  of  a  debilitating  character.  Such  articles  should  be 
selected  as  will  vomit  without  producing  much  general  prostration,  as 
the  sulphates  of  zinc  and  copper. 

In  the  severest  of  all  the  forms  of  inflammation,  I  mean  Laryngitis, 
emetics  are  among  our  most  valuable  resources.  From  the  rapidity 
with  which  this  disease  generally  runs  its  course,  such  remedies  are 
indicated  as  will  operate  with  the  greatest  promptness,  and  among  these 
venesection  and  emetics  take  the  lead.  Bleeding  to  syncope  in  most 
cases  is  the  remedy  first  to  be  applied.  After  this  an  emetic  of  tartar- 
ized  antimony  and  ipecacuanha  is  the  article  best  calculated  to  afford 
relief;  and  it  does  so,  probably,  by  the  copious  secretions  which  it  pro- 
duces from  the  fauces  as  well  as  by  its  general  relaxing  effects  on  the 
system.  The  importance  of  this  remedy  has  not,  it  appears  to  me,  been 
sufficiently  insisted  upon  by  those  who  have  treated  of  this  formidable 
disease. 

In  Bronchitis,  emetics  are  remedies  of  great  utility,  and  they  may  be 
used  with  great  freedom  both  in  children  and  adults.  In  the  early  stage 
of  the  disease,  they  promote  secretion  from  the  inflamed  membrane  and 
produce  general  relaxation,  while  in  the  advanced  periods  they  prove 
advantageous  by  expelling  the  superabundant  secretion  which  is  oppress- 
ing the  lungs  and  interfering  with  the  due  performance  of  the  function 
of  respiration.  In  children,  they  are  the  only  agents  that  we  can  resort 
to  for  relieving  the  lungs  when  oppressed  by  superabundant  secretion. 
In  adults,  tartar  emetic,  and  in  infants,  ipecacuanha  or  antimonial  wine 
and  squills,  may  be  used. 

Bronchitis  is  sometimes  complicated  with  hepatic  disorder,  and  in 
these  cases  emetics  are  doubly  advantageous. 

In  Pertussis,  or  hooping-cough,  emetics  have  been  used  from  time  im- 
memorial, and  their  use  has  received  the  general  sanction  of  professional 
experience.  A  slight  reference  to  the  principal  phenomena  attending 
this  disease  will  show  how  they  may  prove  beneficial.  Whatever  theo- 
ries may  be  entertained  in  relation  to  the  precise  nature  of  this  disease, 
it  is  certain  that  the  mucous  membrane  of  the  larynx,  trachea,  and  lungs 
is  the  principal  seat  of  irritation,  in  consequence  of  which  an  incessant 
secretion  of  viscid  matter  is  taking  place.  The  irritation,  however,  is 
not  confined  to  this  part ;  other  portions  of  the  mucous  membrane  par- 


74  MATERIA   MEDICA   AND   THERAPEUTICS. 

ticipate  in  it,  and  especially  that  which  lines  the  digestive  organs.  The 
secretions  of  the  stomach  and  bowels  are  disordered — they  become  tor- 
pid and  lined  with  viscid  mucus.  The  liver,  -too,  is  congested  and  its 
secretions  deranged.  If  such  be  the  condition  of  things  in  the  lungs, 
the  stomach,  liver,  and  bowels,  it  is  easy  to  see  how  emetics  may  prove 
salutary.  In  the  first  place,  they  unload  the  stomach  of  viscid  mucus 
and  excite  the  torpid  liver.  Next,  they  act  on  the  mucous  lining  of  the 
larynx,  trachea,  and  bronchial  tubes,  promoting  secretion  and  causing 
the  separation  and  expulsion  of  morbid  matters  accumulated  upon  it. 
Independently  of  all  they  prove  salutary  by  their  general  revolutionary 
operation  on  the  system,  by  determining  to  the  surface  and  producing 
relaxation.  Salutary  as  they  are  in  this  complaint,  they  are  not  to  be 
used  indiscriminately.  Regard  must  be  had  to  the  actual  condition  of 
the  system — the  period  of  the  disease — and  the  kind  of  emetic  to  be 
used. 

In  the  commencement  of  the  disease,  when  the  digestive  organs  are 
in  the  condition  described,  an  emetic  should  be  given  with  the  view  of 
producing  its  full  effects,  and  for  this  purpose  a  combination  of  tartar 
emetic  and  ipecacuanha  is  the  best  that  can  be  used. 

In  using  full  emetics  in  this  way  there  are  some  cautions  which  you 
are  to  observe. 

1.  To  examine  very  carefully  the  evacuations  which  may  be  caused 
by  emetics.  Unless  you  do  this,  you  can  form  no  opinion  at  all  of  the 
effect  of  the  remedy. 

2.  The  use  of  full  emetics  ought  not  to  be  repeated  too  often. 
Although  I  approve  highly  of  the  use  of  these  remedies,  yet  I  think 
they  have  been  much  abused  in  this  complaint,  and  the  reason  is 
because  practitioners  generally  form  no  very  distinct  notion  of  the 
object  they  have  in  view  in  their  use.  From  the  incessant  and  long- 
continued  coughing  in  this  complaint,  it  is  to  be  recollected  there  is 
always  more  or  less  determination  created  to  the  brain.  Now,  the 
effect  of  vomiting,  as  is  known,  is  also  to  determine  to  the  brain,  and 
between  the  coughing  and  vomiting,  if  repeated  too  often,  it  will 
frequently  be  found  that  irreparable  mischief  is  done  to  the  brain ;  and 
I  think  I  have  seen  one  case  at  least,  in  which  the  too  free  use  of  emetics 
laid  the  foundation  for  a  subsequent  attack  of  hydrocephalus,  which 
terminated  fatally.  Caution  is  therefore  necessary  in  the  use  of  these 
articles.  Even  if  you  have  no  fears  of  this  kind,  always  select  mild 
articles  if  you  design  to  repeat  the  emetics  often ;  use  ipecac,  rather 
than  tartar  emetic. 

Phthisis  Pulmonalis. — Emetics  at  one  time  enjoyed  a  much  higher 
reputation  in  this  disease  than  they  do  at  present.  That  they  may 
prove  beneficial  by  their  expectorant  action  on  the  bronchitis  usually 
present  in  these  cases  at  some  period  of  the  disease,  is  possible.     So, 


EMETIflB.  75 

too,  they  may  promote  secretion,  equalize  circulation,  and  keep  Dp  a 
determination  to  the  skin — all  objects  of  great  importance.  I  mi  in 
using  emetics  in  phthisis,  it  should  always  be  recollected  tliat  one  of 
the  leading  features  of  the  disease  is  great  constitutional  debility,  and 
of  course  the  use  of  a  debilitating  remedy  like  emetics  should  never  be 
carried  far,  nor  should  such  an  article  as  tartar  emetic  be  used  at  all. 

In  Trachitis  or  croup,  emetics  are  remedies  of  acknowledged  efficacy. 
In  the  different  stages  of  this  disease  they  arc,  however,  to  be  used 
with  different  modifications  and  different  objects.  If  the  disorder  be 
taken  in  its  very  commencement,  before  general  inflammatory  action 
has  yet  come  on,  there  is  no  remedy  so  admirably  calculated  to  break 
up  the  disease  as  emetics.  A  single  emetic  not  unfrequently  relieves 
at  once  the  stricture  under  which  the  trachea  is  laboring,  restores  the 
secretions  of  the  mucous  membrane,  and  renders  respiration  free.  The 
best  article  to  be  used  is  a  combination  of  tartar  emetic  and  ipecacuanha 
or  the  hive  syrup.  In  the  more  advanced  stage  of  the  disease,  where 
inflammatory  fever  is  set  up,  emetics  are  also  to  be  used.  Here  they 
should  be  preceded  by  venesection,  and  the  solution  of  tartarized  anti- 
mony answers  best.  This  should  be  used  in  doses  sufficient  to  produce 
full  vomiting,  and  afterwards  continued  so  as  to  keep  up  nausea  and 
relaxation.  In  the  latter  periods  of  the  disease,  emetics  may  still  be 
resorted  to  with  advantage,  although  for  a  somewhat  different  purpose. 
Inflammatory  action  has  now  subsided,  effusion  has  now  taken  place  in 
the  trachea,  and  a  membrane  has  been  formed  lining  the  canal  which 
mechanically  obstructs  respiration.  By  the  act  of  vomiting,  this  mem- 
brane may  sometimes  be  detached  and  brought  up.  For  this  purpose 
such  emetics  are  to  be  used  as  will  vomit  without  adding  to  the  general 
debility.     The  best  are  the  sulphates  of  zinc  and  copper. 

Diseases  of  the  Abdomen. — In  many  of  these,  emetics  are  remedies 
exceedingly  useful.  They  operate,  1.  By  relieving  the  stomach  of 
foreign  matters  and  morbid  secretions.  2.  By  changing  the  condition 
of  the  mucous  membrane  of  the  stomach  and  promoting  its  secretions. 
3.  By  exciting  the  secretions  of  the  liver.  4.  By  the  concussion  which 
they  give  to  the  abdominal  viscera  during  the  act  of  vomiting.  5.  Bv 
their  general  relaxing  effects  on  the  system  at  large. 

In  all  cases  of  Poisons  taken  into  the  stomach,  whether  mineral  or 
vegetable,  the  first  indication  to  be  attended  to  is  that  of  expelling  the 
poison  from  the  system.  If  the  patient  be  seen  soon  after  taking  the 
poison,  this  can  be  done  frequently  by  the  administration  of  suitable 
emetics,  as  the  object  here  is  simply  to  evacuate  the  stomach  and  to 
produce  this  effect  as  speedily  as  possible.  Such  emetics  are  to  be 
selected  as  operate  with  the  greatest  rapidity,  and  at  the  same  time 
are  confined  in  their  effect,  as  much  as  possible,  to  the  stomach.  The 
best  articles,  therefore,  to  accomplish  these  objects  are  mustard  and  the 

6 


76  MATERIA   MEDICA   AND   THERAPEUTICS. 

sulphates  of  zinc  and  copper  Some  poisons  act  as  local  irritants,  and 
they  produce  vomiting  and  purging.  In  these  cases,  simple  dilution 
with  tepid  water  will  be  sufficient. 

In  almost  all  disordered  states  of  the  stomach,  the  use  of  emetics 
would  naturally  suggest  itself,  and  they  have  been  accordingly  exten- 
sively used.  Experience,  however,  has  shown  that  they  cannot  be  used 
indiscriminately,  proving  salutary  or  noxious  according  to  circumstances. 
As  a  general  rule,  when  inflammation  of  the  mucous  membrane  of  the 
stomach,  whether  acute  or  chronic,  is  present,  they  are  remedies  which 
ought  to  be  used  with  caution.  If  they  should  be  considered  necessary, 
the  mildest  articles  should  always  be  selected.  Where  disorder  of  the 
stomach  is  simply  of  a  functional  character,  emetics  sometimes  are  use- 
ful. They  change  the  secretions  of  this  organ,  by  the  impressions  which 
they  make  upon  the  mucous  membrane,  and  in  that  way  prove  salutary. 
Upon  this  principle,  they  are  sometimes  prescribed  with  effect  in  dys- 
pepsia (see  Eberle's  Pract.  vol.  ii.  291).  In  this  disease,  however,  they 
should  be  used  with  discretion,  and  such  articles  only  selected  as  act 
mildly — such  as  ipecacuanha,  &c.  Tartar  emetic  is  objectionable  in 
every  point  of  view. 

Dysentery  is  another  disease  of  the  abdomen  in  which  emetics  have 
been  prescribed,  and  with  many  high  authorities  they  have  been  in  great 
repute.  In  some  cases  they  prove  exceedingly  salutary,  while  in  others 
they  do  not  appear  to  do  much  good.  The  rationale  of  their  operation 
I  take  to  be  this.  In  this  disease,  along  with  the  local  inflammation  of 
the  mucous  membrane  of  the  large  intestines,  there  is  often  an  engorge- 
ment of  the  liver  and  a  deficient  secretion  of  bile.  This  is  evidenced 
by  the  character  of  the  evacuations.  They  are  simple  blood  and  mucus. 
Now,  the  effect  of  an  emetic  is  to  promote  the  secretion  of  bile,  and  if 
it  should  do  this  freely,  it  would  prove  salutary  in  this  present  case  in 
the  following  ways:  1.  It  would  relieve  the  hepatic  engorgement;  2. 
The  quantity  of  bile  thrown  into  the  intestines  might  act  on  the  bowels 
as  a  cathartic;  3.  It  would  equalize  the  circulation,  and  act  on  the  skin. 
In  all  these  ways  it  would  be  beneficial.  If,  on  the  contrary,  the  emetic 
only  acted  on  the  stomach  without  touching  the  liver,  none  of  these 
beneficial  effects  would  follow.  In  the  use,  therefore,  of  emetics  in  this 
complaint,  there  are  two  things  to  be  attended  to.  In  the  first  place, 
the  selection  of  a  proper  article,  tartar  emetic  or  ipecacuanha.  In  the 
second  place,  it  ought  to  be  given  early  in  the  disease.  It  will  then 
produce  more  effect  than  at  subsequent  periods. 

There  are  only  two  other  affections  of  the  abdomen  which  I  shall 
notice,  for  the  purpose  of  illustration — obstinate  consti'pation  and  jaun- 
dice. In  the  first  of  these,  the  use  of  emetics  is  an  old  remedy.  It  was 
prescribed  even  by  Hippocrates,  and  since  his  time  it  has  been  recom- 
mended by  many  physicians,  both  ancient  and  modern.     In  many  cases 


KMKTICS.  77 

of  this  kind  emetics  certainly  produce  an  admirable  effect,  and  they  act 
both  by  relapsing  spasm  of  the  intestines  and  by  promoting  the  flow  of 
bile.  The  practice,  however,  does  not  always  succeed.  The  cases  of 
constipation  in  which  I  think  it  is  most  likely  to  do  good,  are  those  in 
which  the  disorder  depends  upon  a  torpid  state  of  the  liver. 

Jaundice  arises  from  various  causes;  of  these  I  shall  not  speak.  One 
of  them  is,  the  lodgment  of  calculi  in  the  ducts,  the  effect  of  which 
is  mechanically  to  obstruct  the  passage  of  bile.  Now,  in  this  case, 
emetics  have  been  prescribed  in  some  cases  with  great  effect.  Dr. 
Duncan  relates,  that  in  two  instances  he  saw  upwards  of  thirty  gall 
stones  voided  by  stool  soon  after  the  operation  of  an  emetic  (Eberle's 
Pract.  vol.  ii.  p.  377).  In  such  cases,  the  relaxation  caused  by  the 
emetic  probably  proves  salutary  in  lessening  the  spasm  of  the  duct.  If 
this  be  the  true  explanation,  it  indicates  at  once  the  kind  of  emetic  to 
be  used.  It  ought  to  be  one  that  will  act  freely  on  the  liver,  and  at  the 
same  time  cause  great  relaxation.  Tartar  emetic  is  such  a  one.  The 
mild  emetics  will  not  answer. 

Hemorrhages. — It  is  evident  that  in  cases  depending  upon  the  rup- 
ture of  large  vessels,  emetics  cannot  be  resorted  to  with  any  prospect  of 
advantage.  It  is  only  when  it  occurs  from  capillaries  that  they  can  be 
at  all  applicable,  and  in  these  they  have  been  found  of  great  value.  Of 
the  manner  in  which  they  produce  their  beneficial  effect,  it  is  perhaps 
not  easy  to  give  a  satisfactory  explanation.  It  may,  however,  be  in  one 
or  other  of  the  following  ways  : 

1.  By  their  distributing  more  equally  throughout  the  system  the  cir- 
culating .mass,  and  in  this  way  counteracting  the  local  determination 
upon  which  hemorrhage  depends. 

2.  By  the  revulsive  effect  which  they  produce  upon  the  mucous 
membrane. 

3.  By  their  general  alterative  effect,  more  especially  on  the  mucous 
membrane. 

4.  By  the  nausea  which  they  produce.  "Whatever  be  the  mode  of 
their  operation,  however,  there  can  be  no  question  of  their  utility  in  a 
great  number  of  hemorrhages. 


ILLUSTRATIONS     OF    THE     EFFECTS     OF    EMETICS    IN     PROMOTING    THE    AB- 
SORPTION   OF    MORBID    ENLARGEMENTS. 

Hernia  humoralis. — In  this  affection,  emetics  may  frequently  be 
used  with  the  most  striking  advantage ;  indeed,  in  certain  stages  of  it, 
I  know  of  no  remedy  so  efficacious.  Mr.  Hunter  long  ago  remarked, 
that  he  had  known  the  swelling  removed  almost  instantaneously,  by  the 


18  MATERIA   MEDIC  A  AND  THERAPEUTICS. 

use  of  emetics.*  In  a  great  number  of  cases  I  have  tried  the  practice, 
and  almost  always  with  success.  The  rapidity  with  which  the  swelling 
is  sometimes  diminished  is  really  astonishing.  In  the  case  of  a  gentle- 
man who  had  swelled  testicles  in  consequence  of  gonorrhoea,  all  the 
ordinary  antiphlogistic  means  had  been  used,  together  with  a  blister  to 
the  scrotum.  On  the  seventh  day  from  its  commencement,  although 
the  inflammation  had  been  subdued,  yet  the  tumefaction  remained 
undiminished.  A  full  emetic  of  tartarized  antimony  and  ipecacuanha 
was  now  given,  and  in  two  hours  after  its  operation  the  size  of  the  tes- 
ticle was  reduced  at  least  one-third.  It  is  only,  however,  in  the  passive 
stage  of  this  affection  that  emetics  prove  so  beneficial.  In  the  early 
stage,  where  inflammation  is  present,  they  produce  little  or  no  effect. 

Bubo. — In  this,  emetics  have  also  been  used,  principally,  I  believe,  in 
consequence  of  the  recommendation  of  them  by  John  Hunter.  He 
relates  a  remarkable  instance  of  their  efficacy  in  the  case  of  an  officer 
who  had  a  bubo  at  Lisbon.  In  his  own  words,  "  it  came  to  a  fair  sup- 
puration, and  was  almost  ready  to  burst.  The  skin  was  thin  and 
inflamed ;  and  a  plain  fluctuation  was  felt.  I  intended  to  open  it,  but 
as  he  was  going  on  board  a  ship  for  England  on  the  day  following,  I 
thought  it  better  to  defer  it.  When  he  went  on  board,  he  set  sail 
immediately,  and  the  wind  blew  so  hard  that  nothing  could  be  done  for 
some  days,  all  which  time  he  was  very  sick,  and  vomited  a  good  deal ; 
when  the  sickness  went  of,  he  found  the  bubo  had  disappeared,  and  it 
never  afterwards  appeared."!  Mr.  Hunter  explains  the  effect  in  this 
case  upon  the  principle  of  "  one  irritation  destroying  another,  and 
the  sickness  and  the  act  of  vomiting  perhaps  giving  a  disposition  to 
absorption."  In  cases  of  this  kind,  the  use  of  emetics  is  not  followed, 
however,  by  the  same  marked  effect  as  in  hernia  humoralis, — a  single 
emetic  produces  but  little  effect,  and  they  require  to  be  repeated  for 
several  days  in  succession,  imitating  in  this  way  as  nearly  as  possible 
the  effect  of  sea-sickness.^ 

In  morbid  enlargements  of  other  parts,  emetics  may  sometimes  prove 
very  beneficial.  Mr.  Cruikshank  mentions  a  case  of  swelling  of  the 
knee,  which  was  cured  by  the  patient  vomiting  for  forty-eight  hours,  in 
consequence  of  his  taking  a  large  dose  of  the  salt  of  tartar  (carb.  potass.) 
instead  of  soluble  tartar  (tartar  potass.).     Rush,  vol.  ii.  p.  182. 

*  Treatise  on  the  Venereal  Disease,  p.  84.     See  also  Benj.  Bell,  vol.  i.  p.  204. 

f  On  the  Venereal,  p.  250. 

\  Swedian  says,  "  Success  has  attended  the  use  of  emetics,  repeated  for  two  or 
three  days;  in  this  way  buboes  have  been  discussed,  which  were  ready  to  burst." 
—P.  225. 


EMETICS.  70 


INDIVIDUAL  EMETICS. 


IPECACUANHA. 


This  article  is  the  product  of  the  Cephaelis  Ipecacuanha,  a  plant  found 
native  in  the  Brazils.  It  grows  to  about  the  height  of  a  foot,  and  flour- 
ishes in  moist  and  shady  situations.  The  root  is  from  four  to  six  inches 
long,  and  about  the  size  of  a  goose  quill.  The  plant  flowers  in  the 
months  of  January,  February,  and  March,  and  during  this  period,  the 
root,  which  is  the  part  used  in  medicine,  is  collected.  It  is  separated 
from  the  stem,  and  after  being  cleansed,  is  hung  up  in  the  sun  to  dry. 
In  this  state  it  is  exported  in  bales. 

Physical  Characters  of  the  Root. — The  root  comes  in  pieces  about 
three  or  four  inches  long,  and  at  its  thickest  part  about  the  size  of  a  goose 
quill.  It  is  irregularly  bent  and  twisted,  and  surrounded  by  numerous 
rings  of  various  sizes,  separated  from  each  other  by  circular  grooves  or 
depressions.  It  is  from  this  circumstance  that  the  genuine  ipecacuanha 
root  is  termed  -annulated.  The  cortical  part  makes  up  the  largest  propor- 
tion of  the  root,  constituting  about  four  fifths  of  the  whole.  It  is  thick, 
of  a  horny  hardness,  and  breaks  with  a  resinous  fracture.  It  is  this  which 
principally  contains  the  active  properties  of  the  root.  The  woody  part  is 
a  thin  cord  of  a  whitish  color,  and  is  nearly  inert.  The  powder  of  the 
ipecacuanha  is  of  a  light  yellowish  color,  having  a  faint  and  disagreeable 
smell,  with  a  bitter,  sub-acid,  and  nauseous  taste.  By  exposure  to  lio;ht 
and  air,  the  active  properties  of  it  are  liable  to  be  impaired.  For  the 
purpose  of  preserving  it,  therefore,  it  should  be  kept  in  vials  well  corked 
and  secluded  from  the  light. 

Varieties  of  the  genuine  Ipecacuanha  Root — As  found  in,,  the  market, 
three  of  them  are  recognised,  distinguished  from  each  other  by  their 
color,  viz.  the  brown,  the  red,  and  the  grey.  All  these,  however,  are 
annulated  and  are  derived  from  the  same  plant, — the  cephaelis  ipecacu- 
anha,— the  varieties  of  color  being  owing  simply  to  difference  in  the  ace 
of  the  root,  the  nature  of  the  soil,  the  mode  of  drying,  ttc. 

Besides  the  foregoing,  which  is  the  genuine  root,  there  are  two  others, 
which  are  sometimes  brought  into  the  market  and  which  pass  under  the 
general  name  of  ipecacuanha. 

(a.)  The  first  of  these  is  the  Striated  Ipecacuanha.  This  is  the  pro- 
duct of  the  Psycotria  emetica,  a  small  shrub  from  fourteen  to  eighteen 
inches  in  height,  growing  in  Peru,  and  some  other  parts  of  South  Ame- 
rica. It  is  known  by  the  name  of  the  Peruvian  ipecacuanha  ;  and  from 
the  dark  color  of  the  epidermis  when  dry,  it  is  sometimes  called  the 
black  ijweacuanha.  This  root  is  destitute  of  the  rings  which  characterize 
the  genuine  root — the  ridges  on  the  surface  being    longitudinal — and 


80  MATERIA   MEDICA   AND  THERAPEUTICS. 

from  this  circumstance  it  has  received  the  name  of  striated.  The  woody 
part  of  the  root  is  much  greater  in  proportion  to  the  cortical  than  it  is 
in  the  genuine  ipecacuanha. 

(b.)  The  Undulated  fyecacuanha.  This  is  obtained  from  the  Richard- 
sonia  scabra,  a  plant  growing  in  the  Brazils.  It  is  also  called  the  white 
ipecacuanha.  The  surface  of  the  root  has  no  rings  upon  it,  hut  presents 
an  undulated  or  wave-like  appearance,  with  indentations  on  one  side 
and  prominences  on  the  other.  When  broken,  it  presents  a  dull,  white, 
farinaceous  appearance. 

Chemical  Composition.- — The  discover)'  of  the  active  principle  of  ipe- 
cacuanha is  one  of  the  triumphs  of  modern  chemistry.  By  Majendie 
and  Pelletier,  in  1817,  the  presence  of  an  alkaline  principle  was  esta- 
blished, to  which  the  name  of  Emetine  was  given,  but  since  then  it  has 
been  called  by  the  name  of  Emetia.  It  is  upon  this  principle  that  the 
active  properties  of  this  drug  are  supposed  to  depend.  Analysis  has 
proved  that  emetine  exists  in  various  proportions  in  the  different  varie- 
ties. In  100  parts  of  the  cortical  part  of  the  hroivn  annulated  ipecacu- 
anha, there  were  16  parts  of  impure  emetine,  and  in  the  ligneous  part, 
1*15.  The  red  annulated  ipecacuanha  contains  14  parts  of  emetine  in 
100.  The  grey  not  analysed.  The  root  of  the  Psycotria  emetica  was 
found  to  contain  only  9  parts  of  emetine  in  100,  and  that  of  Richard- 
sonia  scabra  only  6  parts  in  100. 

Besides  emetine,  the  other  ingredients  found  in  the  ipecacuanha  root, 
are  variable  proportions  of  starch,  fatty  matter,  wax,  gum,  ligneous  mat- 
ter, and  traces  of  gallic  acid. 

Ipecacuanha  is  partly  soluble  both  in  water  and  in  alcohol.  By  de- 
coction, its  virtues  are  impaired. 

Effects. — These  vary  with  the  dose.  In  very  small  doses,  it  promotes 
secretion  from  the  mucous  membrane  of  the  stomach,  excites  the  appe- 
tite, and  promotes  digestion.  In  doses  somewhat  larger,  and  yet  not 
sufficient  to  cause  vomiting,  it  produces  nausea,  and  acts  upon  the 
bowels,  increasing  secretion  from  the  mucous  membrane,  and  causing 
evacuations  from  those  organs.  In  doses  sufficient  to  excite  nausea,  it 
extends  its  influence  to  the  mucous  lining  of  the  pulmonary  organs,  pro- 
moting secretion  and  expectoration.  In  suitable  closes,  it  produces 
vomiting.  As  an  emetic,  this  article  is  distinguished  by  the  certainty 
as  well  as  mildness  with  which  it  operates.  Given  in  large  doses,  it 
never  acts  as  a  local  irritant,  and  scarcely  ever  excites  excessive  vomit- 
ing. As  a  general  rule,  it  appears  to  be  thrown  off  from  the  stomach 
in  the  first  vomitings.  This  may  account,  no  doubt,  in  some  cases,  for 
its  not  operating  more  violently.  The  evacuations  produced  by  it  are 
not  usually  bilious.  This  would  seem  to  show  that  its  action  is  not 
extended  to  the  liver  in  any  special  manner.  On  the  system  at  large, 
its  action  is  not  attended  with  tha^pjostration,  which  characterizes  some 


EMETIC8.  81 

other  emetic  agents.  From  all  tin's,  the  uses  of  this  article  are  evident. 
Whenever  it  is  desirable,  by  means  of  an  emetic,  not  merely  to  evacuate 
the  stomach,  but  to  make  a  peculiar  impression  on  the  mucous  tissue, 
and  to  promote  secretion  from  it,  without  producing  any  great  general 
prostration  or  relaxation,  this  is  the  best  article  that  can  be  used. 

From  the  mildness  with  which  ipecacuanha  operates,  it  is  admirably 
suited  as  an  emetic  for  children. 

It  is  important  to  recollect  that,  upon  some  constitutions,  this  article 
produces  anomalous  and  unpleasant  effects.  The  mere  odor,  in  some 
persons,  frequently  excites  the  most  distressing  symptoms.  Asthmatics 
are  very  commonly  distressed,  and  a  paroxysm  brought  on,  by  the  smell 
of  ipecacuanha. 

Modes  of  Administration.  1.  Powder. — This  is  the  form  in  which 
it  is  generally  used,  and  for  an  adult  the  dose  is  from  15  to  30  grains 
mixed  in  a  little  water.     Young  infants  ■£  gr.  to  1  gr. 

2.  The  Wine  of  Ipecacuanha. — This  is  prepared  by  macerating  §  i 
of  the  bruised  root  in. a  pint  of  sherry  wine  for  two  weeks,  and  then 
straining.  It  is  a  good  preparation,  possessing  all  the  virtues  of  the 
powder.  To  an  adult  the  dose  of  an  emetic  is  about  an  _ounce ;  to  a 
child  of  from  one  to  two  years,  about  a  drachm,  to  be  repeated  every 
fifteen  or  twenty  minutes  till  it  operates.  [The  quantity  of  wine  renders 
this  an  objectionable  preparation  for  children.  The  syrup  is  better. — 
Ed.] 

3.  Syrup  of  Ipecacuanha. — Process  TJ.  S.  Disp. — Take  of  ipecacuanha 
in  coarse  powder  1  ounce,  diluted  alcohol  1  pint,  syrup  two  pints. 
Macerate  the  ipecacuanha  in  the  alcoliol  for  fourteen  days,  then  filter, 
evaporate  the  filtered  liquor  to  two  ounces,  then  filter  again  and  mix  with 
the  syrup,  and  evaporate  by  means  of  a  water  bath  to  a  proper  consist- 
ence. This  is  an  excellent  preparation  for  children.  Dose  as  an  emetic 
half  to  one  teaspoonful — for  an  adult,    3  i  to   3  iss. 

Emetia  or  Emetine. — This  is  the  peculiar  substance  which  exists  in 
ipecacuanha,  and  on  which  its  value  depends.  It  was  discovered  by 
Pelletier  in  1817. 

Properties. — Pure  emetine  is  in  the  state  of  a  whitepowd.er,  with  a 
taste  slightly  bitter  and  without  smell.  Exposure  to  the  air  does  not 
affect  it.  In  cold  water  it  is  slightly  soluble — in  warm  water  rather 
more  so.  In  alcohol  it  is  very  soluble.  It  restores  the  color  of  vegetable 
biues  and  combines  with  the  acids,  forming  crystallizable  salts.  It  is 
therefore  a  vegetable  alkali. 

Effects. — The  same  as  ipecacuanha.  According  to  Maguire  two 
grains  of  the  pure  emetine  are  sufficient  to  kill  a  dog,  and  in  the  human 
subject  he  has  seen  one  sixteenth  of  a  grain  produce  vomiting. 

Forms  of  Administration. — As  the  pure  emetine  is  very  insoluble, 


82  MATERIA   MEDICA   AND  THERAPEUTICS. 

it  is  previously  to  be  dissolved  in  a  little  sulphuric  or  acetic  acid  and 
then  taken  in  rain  water.  Or  the  simple  emetine  may  be  taken  mixed  in 
syrup.  The  dose  is  about  one  quarter  of  a  grain.  The  best  mode  of 
taking  it  is  to  dissolve  one  grain  in  a  little  acetic  acid  and  then  add 
three  or  four  ounces  of  rain  water.  Half  an  ounce  may  then  be  taken 
every  fifteen  or  twenty  minutes  until  vomiting  is  produced. 


TARTAR    EMETIC. 

This  is  the  tartrate  of  antimony  and  potash,  and  is  the  most  valuable 
of  the  preparations  of  antimony.  It  does  not  exist  native,  but  is  always 
prepared  artificially.  It  is  said  to  have  been  first  made  by  Adrier 
Mynsicht,  in  1631.     It  is  prepared  thus  : — 

Take  of  sulphuret  of  antimony,  in  fine  powder,  four  ounces  ;  muriatic 
acid,  twenty-five  ounces ;  nitric  acid,  two  drachms ;  water,  a  gallon. 
Mix  the  acids  in  a  glass  and  add  by  degrees  the  sulphuret  of  antimony ; 
digest  the  mixture  with  a  gradually  increased  heat  till  effervescence 
ceases ;  then  boil  for  one  hour ;  filter  when  the  liquid  is  cold  and  pour 
it  into  the  water ;  wash  the  precipitate  till  quite  free  from  acid  and  dry 
it,  and  take  of  this  two  ounces ;  bitartrate  of  potassa  in  very  fine  powder, 
two  ounces  and  a  half;  distilled  water,  eighteen  fluid  ounces ;  boil  the 
water  in  a  glass  vessel,  then  add  the  powders  previously  mixed  and  boil 
for  an  hour ;  lastly,  filter  when  hot  and  set  aside  to  crystallize.  The 
mother  liquor  will  yield  by  evaporation  additional  crystals  which  are  to 
be  purified  by  another  crystallization. 

Properties. — Tartar  emetic  is  a  crystalline  salt  of  a  pure  white  color, 
with  a  styptic  metallic  taste,  but  without  any  smell ;  on  exposure  to  the 
air,  it  slightly  effloresces  on  the  surface  and  becomes  opaque.  In  alcohol 
tartar  emetic  is  insoluble.  It  is  soluble  in  fourteen  times  its  weight  of 
cold,  and  twice  its  weight  of  boiling  water.  If  the  aqueous  solution  be 
kept  for  some  time  it  decomposes  spontaneously.  (This  is  owing  to  the 
decomposition  of  the  tartaric  acid.     Murray,  p.  446.) 

Purity. — As  this  article  is  only  used  in  small  doses,  it  is  important  to 
have  it  pure.     As  found  in  the  shops,  it  may  be  in  two  different  states 

in  that  of  crystal  or  that  of  powder.     The  last  of  these  is  the  most 

common  and  most  likely  to  be  adulterated.  As  a  general  rule,  there- 
fore, it  is  best  to  purchase  it  in  the  form  of  crystal.  In  this  state  of 
course  there  can  be  no  other  impurity  than  such  as  may  arise  from  the 
imperfect  preparation  of  the  salt,  while  in  the  form  of  powder  various 
substances  may  be  mixed  up  with  it. 

Tests  of  the  Purity  of  Tartar  Emetic. — The  salt  should  be  entirely 
soluble  in  twenty  parts  of  water,  the  solution  not  effected  by  ferrocya- 
nide  of  potassium.    A  more  delicate  test : — dissolve  one  part  of  the  sus- 


EMETICS. 


83 


pected  salt  in  forty  parts  of  water;  dissolve  eight  parte  of  the  acetate  of 
lead  in  thirty-two  parts  of  water  and  fifteen  parts  of  acetic  acid  ;  mix  the 
solutions;  if  a  precipitate  appear,  cream  of  tartar  is  present.  Rationale. 
The  strongly  acid  solution  of  the  acetate  of  lead  holds  the  tartar  emetic 
in  solution  hut  lets  fall  the  cream  of  tartar.  This  test  will  detect  one 
per  cent,  of  cream  of  tartar. 

Physiological  Effects. — In  small  and  repeated  doses,  tartar  emetic 
promotes  the  secretions  of  the  mucous  membrane  and  of  the  skin,  and 
lessens  the  action  of  the  heart  and  blood-vessels.  In  larger  doses,  it  acts 
as  an  emetic.  In  still  larger,  as  a  local  irritant,  producing  heat  and 
pain  in  the  stomach,  frequent  and  severe  vomiting,  and  sometimes  hic- 
cup. Along  with  this  there  are  acute  colicky  pains  in  the  bowels,  toge- 
ther with  free  purging.  To  this  succeed  general  prostration,  severe 
cramps,  delirium,  convulsions,  and  death.  In  some  cases,  neither  vomit- 
ing nor  purging  has  occurred,  and  this  has  always  been  attended  with 
an  aggravation  of  the  other  symptoms.  In  other  cases,  there  has  been 
a  peculiar  difficulty  of  swallowing  so  as  almost  to  prevent  it  altogether. 
On  dissection,  in  cases  of  poisoning,  the  mucous  membrane  of  the 
stomach  and  intestines  has  been  found  inflamed.  In  his  experiments 
upon  animals,  Majendie  also  found  the  lungs  inflamed.  As  an  emetic, 
this  article  is  peculiar,  operating  with  great  certainty  and  activity  upon 
the  stomach  and  abdominal  viscera,  and  at  the  same  time  producing 
general  relaxation.  Between  this  and  ipecacuanha,  there  are  several 
important  points  of  difference.  It  makes  a  more  permanent  impression 
on  the  stomach  itself,  and  in  consequence  of  this  causes  a  more  full  and 
perfect  evacuation  of  that  organ.  Its  action  is  not  so  much  confined  to 
the  stomach  as  that  of  ipecacuanha.  Its  influence  extends  to  the  duo- 
denum, inverting  the  action  of  that  intestine,  and  at  the  same  time  ex- 
citing the  liver  and  promoting  the  secretion  of  bile.  Hence  it  is  that 
free  discharges  of  bile  attend  the  operation  of  this  emetic. 

It  extends  its  influence  to  the  intestinal  canal,  causing  free  evacua- 
tions from  the  bowels.  This  is  owing,  in  part,  to  the  free  secretion  of 
bile  into  the  intestines,  and  in  part  to  the  general  relaxation  which  it 
produces.  It  affects  the  skin  more,  producing  freer  perspiration  than 
other  emetics.  Finally,  it  affects  the  whole  system  more  powerfully, 
lessening  arterial  action  and  causing  more  general  relaxation  and  ex- 
haustion. 

From  the  foregoing  view  of  the  effects  and  peculiarities  of  this  article  as 
an  emetic,  it  is  evident  that  there  are  conditions  of  the  stomach  and  of 
the  system  in  which  it  may  be  used  with  great  advantage,  while  in  other 
conditions  it  is  wholly  inadmissible.  Where  the  object  is  simply  to 
evacuate  the  contents  of  the  stomach — where  that  organ  is  debilitated 
and  irritable — where  there  is  general  debility  or  considerable  prostra- 
tion of  strength,  this  active  medicine  may  do  much  injury;  and  ought 


84  MATERIA   HEDICA  AND   THERAPEUTICS. 

to  be  carefully  abstained  from.  On  the  other  hand,  when  you  wish  to 
make  a  powerful  impression  on  the  stomach  and  abdominal  viscera,  and 
at  the  same  time  to  cause  general  relaxation,  there  is  no  article  which 
can  be  compared  with  it. 

Tartar,  emetic  is  an  article  which  ought  to  be  used  with  great  caution. 

Mode  of  Administration. — When  used  as  an  emetic,  this  article  is 
given  in  solution  with  pure  water,  and  to  an  adult  in  doses  of  two  or 
three  grains.  This  generally  produces  full  vomiting  The  better  method, 
however,  is  to  give  it  in  divided  doses.  For  this  purpose,  two  or  three 
grains  are  dissolved  in  three  or  four  ounces  of  water — of  this  one  fourth 
may  be  taken  every  quarter  of  an  hour  until  vomiting  is  produced.  The 
operation  of  it  is  to  be  assisted  by  the  free  use  of  warm  water  or  chamo- 
mile tea.  Given  in  this  way,  you  have  the  operation  of  this  article  more 
under  your  immediate  control,  and  you  guard  against  the  unpleasant 
effects  which  sometimes  result  from  the  use  of  a  large  dose  given  at 
once. 

To  children,  one  eighth  to  one  sixteenth  of  a  grain.  But  it  should 
never  be  given  where  gastric  or  intestinal  irritation  is  present,  nor  unless 
inflammatory  action  requires  it. 

Antimonial  Wine. — This  is  prepared  by  dissolving  two  scruples  of 
tartar  emetic  in  twenty  ounces  of  wine.  Each  fluid  ounce,  therefore, 
contains  two  grains  of  the  tartar  emetic.  The  strength  of  antimonial 
wine  depends  entirely  upon  the  care  with  which  it  is  prepared.  If  the 
tartar  emetic  be  impure,  or  the  wine  be  not  of  the  proper  kind,  decom- 
position takes  place,  which  impairs  its  activity.  As  the  result  of  inves- 
tigation, it  has  been  ascertained  that  good  sherry  is  the  only  kind  of  wine 
which  does  not  decompose  the  antimony.  Every  other  wine  acts  upon  it  in 
such  way  as  sometimes  scarcely  to  leave  any  trace  of  the  antimonial  salt 
in  the  preparation.  The  way  in  which  the  decomposition  takes  place, 
is  by  the  potash  of  the  tartar  emetic  attracting  tartaric  acid  from  the 
wine,  and  thus  breaking  up  the  affinity  which  keeps  together  the  potash 
and  the  antimony.  In  consequence  of  this,  a  precipitate  is  thrown  down, 
consisting  of  oxide  of  antimony,  with  a  portion  of  super-tartrate  of 
potash.  Sherry  wine,  being  free  from  acid,  obviates  this  effect.  If  the 
tartar  emetic,  too,  should  be  impure,  mixed  for  example  with  super- 
tartrate  of  potash,  there  will  be  a  precipitation,  although  the  strength 
of  the  solution  may  not  be  affected.  To  have  it  good,  therefore,  and  to 
obtain  a  perfect  solution,  it  is  necessary  to  employ  the  pure  crystallized 
tartar  emetic  and  good  sherry  wine. 

The  advantage  of  this  preparation  is,  that  it  supplies  us  with  a  per- 
manent solution  of  tartar  emetic,  by  which  very  minute  doses  can  be 
given.  On  this  account  it  is  much  used  for  children.  From  what  has 
been  said,  it  is  evident  that  this  preparation  is  very  liable  to  be  uncertain 


*  EMETICS.  85 

in  its  strength;  and  on  tin's  account,  in  acute  cases,  preference  should 

always  be  given  to  the  watery  solution  of  tartar  emetic. 

Dose. — As  an  emetic  for  children,  half  a  drachm  may  be  given  every 
fifteen  minutes  until  it  operate.  [I  believe  this  preparation  ought  to  be 
dropped.  It  is  always  ol>  uncertain  strength.  Sherry  wine  containing 
no  acid  cannot  be  had.  I  rejoice  to  say  that  it  is  infinitely  less  used  in 
New  York  now  than  formerly.  Especially  should  its  use  as  a  domestic 
remedy  be  discouraged.] 


SULPHATE    OF    ZINC. 

Zinc  was  not  known  to  the  Greeks  or  Romans,  although  they  were 
aware  of  the  method  of  converting  copper  into  brass  by  means  of  an  ore 
of  zinc.  It  was  first  noticed  in  1280.  The  preparation  at  present  under 
consideration  was  first  known  in  Germany  about  the  middle  of  the  six- 
teenth century.  In  the  mines  of  Goslar,  in  Germany,  it  is  found  native 
— what  is  used  in  medicine  is  prepared  artificially. 

There  are  two  kinds  of  it  met  with  in  the  shops.  The  impure,  ov  what 
is  commonly  called  white  vitriol,  and  the  pure  or  crystallized. 

Sulphate  of  zinc  is  prepared  by  the  direct  combination  of  its  consti- 
tuents. For  this  purpose  zinc,  cut  into  small  pieces,  is  subjected  to  the 
action  of  diluted  sulphuric  acid — effervescence  takes  place  ;  when  this  is 
finished,  the  solution  is  filtered  through  paper;  it  is  then  boiled  down 
until  a  pellicle  appears,  and  set  aside  to  crystallize.  Here  water  is  first 
decomposed.  The  zinc  is  oxidized  and  then  the  sulphuric  acid  unites 
with  it.     The  hydrogen  escaping  causes  the  effervescence. 

Properties. — When  pure,  this  salt  exists  in  the  form  of  small  white 
rhombic  prisms,  resembling  crystals  of  sulphate  of  magnesia.  It  has  no 
smell,  but  has  a  styptic  metallic  taste ;  when  exposed  to  dry  air  it 
slightly  effloresces — soluble  both  in  hot  and  cold  water.  Two  and  a 
half  times  its  weight  of  the  latter,  and  less  than  its  own  weight  of  the 
former.     In  alcohol  it  is  insoluble. 

Effects. — Sulphate  of  zinc  is  a  powerful  and  in  many  cases  a  valuable 
emetic.  It  is  peculiar  in  its  action,  combining  with  its  emetic  operation 
the  effect  of  a  local  astringent,  checking  secretion  from  the  mucous 
membrane  of  the  alimentary  and  pulmonary  tissues.  It  is  more  speedy 
in  its  operation  than  any  of  the  preceding  articles.  Unlike  ipecac,  and 
tartar  emetic  it  causes  little  or  no  nausea,  and  does  not  produce  repeated 
emesis.  On  the  mucous  membrane  it  acts  powerfully  as  an  astringent, 
separating  and  clearing  out  morbid  accumulations  of  mucus,  and 
moderating  and  even  suspending  secretion  for  a  time  after  its  operation. 
On  the  system  at  large,  it  does  not  produce  any  of  the  debilitating  and 


86  MATERIA   MEDICA   AND   THERAPEUTICS. 

relaxing  effects  which  follow  the  use  of  other  emetics ;  and  even  the 
stomach  itself  seems  to  be  invigorated  after  its  action. 

As  an  emetic,  it  is  suited  to  all  such  cases  as  require  a  prompt  and 
complete  evacuation  of  the  stomach,  unaccompanied  by  any  relaxing 
effects  on  the  system.  The  most  frequent  use  of  it  is  in  cases  of 
poisoning.  It  is  also  used,  in  cases  where  it  is  desired,  by  means  of  an 
emetic,  to  unload  the  pulmonary  organs  of  superabundant  mucous  secre- 
tion, and  to  check  the  further  secretion  of  it. 

In  excessive  doses,  sulphate  of  zinc  operates  as  an  irritant  poison. 

In  using  this  article,  the  crystallized  ought  always  to  be  preferred.  It 
is  purer,  and  in  consequence  of  its  containing  more  water  of  crystalliza- 
tion, not  so  strong. 

Dose,  &c. — For  an  adult,  10  to  20  grs.  as  an  emetic.  To  be  taken  in 
|  ij  of  mint  or  common  water,  with  the  addition  of  f  i  of  sp.  lavender. 
For  children,  grs.  ij  may  be  dissolved  in  §  j  of  water — a  teaspoonful 
every  ten  or  fifteen  minutes. 


SULPHATE    OF    COPPER. 

Known  by  the  common  names  of  blue  vitriol,  blue  stone,  &c. 
There  are  several  modes  in  which  this  article  is  obtained. 

1.  From  the  native  sulphuret.  By  exposure  to  a  moist  atmosphere 
this  undergoes  chemical  changes ;  the  sulphur  is  converted  into  sulphuric 
acid,  while  the  copper  is  oxidized,  and  thus  the  sulphate  is  formed.  In 
this  state  it  is  washed  down  by  the  rain  and  other  waters  of  the  mines. 
By  simply  evaporating  these  waters  the  salt  is  obtained.  A  large  pro- 
portion of  it  is  thus  obtained  from  the  copper  mines. 

2.  A  second  mode  is  to  roast  the  copper  pyrites  (sulphuret  of  copper) 
in  a  reverberatory  furnace,  during  which  it  absorbs  oxygen  and  is 
converted  into  the  sulphate.  It  is  then  lixiviated  and  the  solution 
evaporated  till  it  forms  crystals. 

3.  The  third  mode  is  by  the  direct  action  of  sulphuric  acid  on 
copper.  This  is  the  mode  in  which  it  is  usually  prepared  in  this 
country. 

Properties. — A  crystalline  salt  of  a  beautiful  deep  blue  color.  The 
crystals  are  semi-transparent,  and  when  exposed  to  the  air  slightly 
effloresce — without  smell,  but  has  a  harsh,  styptic,  metallic  taste.  •  Solu- 
ble in  four  parts  of  water  at  60°,  and  in  less  than  two  parts  at  212°. 
In  alcohol  insoluble. 

Purity. — The  sulphate  of  copper  of  the  shops  is  generally  very  pure. 
The  only  adulteration  which  it  sometimes  contains  is  sulphate  of  iron, 
existing  in  the  native  sulphuret. 

Effects. — In  its  local  action  astringent,  and  in  large  doses  irritant. 


EMETICS.  87 

As  an  emetic,  prompt  and  powerful — very  analogous  to  the  sulphate  of 
zinc  used  in  the  same  cases,  especially  in  poisoning.  Not  so  good, 
however,  as  the  sulphate  of  zinc,  because  more  apt  to  cause  local  irrita- 
tion and  inflammation,  where  it  is  retained,  as  is  frequently  the  case  in 
poisoning  by  narcotic  agents. 

Dose. — Adults,  5  to  10  grs.  dissolved  in  two  or  three  ounces  of 
water.  Children,  one  eighth  to  one  sixth  gr.  every  quarter  of  an 
hour. 

SQUILL. 

The  product  of  the  Scilla  maritima,  the  Sea  Onion,  a  perennial  plant 
growing  to  the  height  of  two  or  three  feet,  shooting  from  a  large  bulb, 
with  fibrous  roots.  It  grows  native  on  the  sandy  shores  of  the  Medi- 
terranean, in  France,  Spain,  Italy,  Greece,  Syria,  and  Barbary.  The 
part  used  in  medicine  is  the  bulb.  In  its  appearance  this  resembles  the 
common  onion,  though  much  larger.  Its  size  varies  from  that  of  a 
man's  fist  to  a  child's  head.  It  is  composed  of  concentric  layers  or 
scales,  each  of  which  is  covered  with  a  thin  membrane  of  a  whitish 
color.  The  fresh  bulb  contains  a  large  proportion  of  acrid  juice,  which 
inflames  and  vesicates  the  skin.  By  drying,  the  greater  part  of  this 
acridity  is  dissipated.  For  medicinal  purposes,  the  bulb  is  cut  into 
small  slices  and  dried.  In  the  shops,  there  are  found  two  varieties  of 
it — viz.  the  red  and  the  white.  In  medicinal  properties  they  do  not 
differ,  and  are  used  indiscriminately.  The  squill  has  no  smell — taste 
bitter,  acrid,  and  nauseous — as  it  has  a  great  affinity  for  moisture,  and 
then  becomes  mouldy,  it  should  be  kept  in  tightly  corked  bottles. 

Composition. — According  to  the  analysis  of  Vogel,  the  dried  squill 
contains  an  acrid  volatile  matter — a  bitter  substance  called  scUlitinaj 
tannin,  gum,  citrate  of  lime,  and  lignin.  Its  active  properties  are 
extracted  by  water,  vinegar,  and  alcohol. 

Scillitina. — According  to  Vogel,  100  parts  of  the  dried  squill  yielded 
35  of  this  principle.  A  whitish  transparent  deliquescent  substance, 
which,  when  dry,  has  a  resinous  fracture,  and  may  readily  be  reduced 
to  powder.  Its  taste  is  bitter  and  subsequently  sweetish.  It  readily 
dissolves  in  water,  spirits  of  wine,  and  acetic  acid. 

The  substance  sold  in  the  shops  as  scillitina  is  a  treacle-like  liquid. 

Effects. — In  small  doses,  squill  acts  as  a  stimulant  to  the  mucous 
membrane — especially  the  bronchial  and  gastro-intestinal  portions  of  it, 
promoting  secretions  from  them.  At  the  same  time  it  excites  the 
secretory  action  of  the  kidneys. 

In  larger  doses,  it  causes  nausea,  vomiting,  and  sometimes  purging. 
With  regard  to  its  action  on  the  circulation,  there  is  a  difference  of 
opinion.  By  some  it  is  supposed  to  excite  the  pulse,  and,  therefore,  is 
objected  to  in  all  cases  where  inflammatory  action  is  present.     This, 


88  MATERIA   MEDICA   AND   THERAPEUTICS. 

however,  does  not  appear  to  be  the  case.  As  a  general  rule  it  does 
not  excite  the  circulation.  Nevertheless,  from  its  acting  as  a  local 
stimulant,  it  is  not  suitable  where  inflammation  is  present. 

In  excessive  doses,  it  acts  as  a  narcotico-acrid  poison,  causing  severe 
vomiting,  purging,  griping,  strangury,  inflammation  of  the  stomach  and 
intestines,  convulsions,  and  death.  24  grs.  of  the  powder  have  proved 
fatal. 

As  an  emetic,  this  article  is  little  used  at  present,  except  for 
children. 

A  great  objection  to  it  is  the  uncertainty  of  its  action.  In  some 
cases  very  small  doses  cause  severe  vomiting,  while  in  others  large 
doses  produce  but  little  effect.  It  is  objectionable,  too,  where  the 
stomach  is  irritable. 

Forms. — Powder. — Ten  grs.  act  as  an  emetic  in  an  adult.  Not  used 
in  this  way. 

In  children  the  only  forms  in  which  it  is  used  are  those  of  oxymel  or 
syrwp. 

Oxymel. — Prepared  by  boiling  the  vinegar  of  squill  with  honey. 

Syrup. — Boiling  vinegar  of  squill  with  sugar.  Dose — half  a  tea- 
spoonful  to  a  teaspoonful  every  quarter  of  an  hour  till  it  operates. 


LOBELIA   INFLATA. 

This  is  a  biennial  plant,  known  by  the  common  names  of  the  Indian 
tobacco,  wild  tobacco,  emetic  weed,  &c.  It  grows  native  in  every  part  of 
the  United  States,  and  is  generally  found  along  road  sides  and  in  old 
uncultivated  fields.  It  rises  to  the  height  of  from  one  to  two  feet,  with 
a  single,  erect,  hairy  stem,  branching  about  midway.  The  fruit  is  an 
oval,  striated,  inflated  capsule,  containing  in  its  two  cells  a  great  num- 
ber of  small  brown  seeds.  It  commences  flowering  in  the  month  of 
July,  and  continues  in  bloom  until  November.  When  broken  or  cut  it 
emits  a  milky  juice.  The  proper  period  for  gathering  this  plant  is  in 
the  months  of  August  and  September,  when  the  capsules  are  full  and 
numerous,  and  when  the  leaves  are  just  beginning  to  fade.  It  is  then 
to  be  plucked  up  by  the  roots  and  dried  quickly,  either  in  the  sun  or  in 
an  oven.  It  may  be  kept  whole  or  in  powder.  It  should  always  be 
packed  tightly  and  kept  for  some  time  in  a  dark  place.  Every  part  of 
the  plant  possesses  medicinal  properties ;  but  the  parts  most  powerful 
are  the  leaves  and  capsules.     These  should,  therefore,  be  preferred. 

Physical  Properties.— Indian  tobacco,  when  dried,  has  a  smell  slightly 
irritating.  When  chewed  for  a  short  time,  its  taste  is  acrid,  resembling 
that  of  common  tobacco,  and  like  that,  too,  causes  a  flow  of  saliva,  sick- 
ness at  stomach,  and  giddiness.     Its  powder  is  of  a  greenish  color. 


EMKTICB.  89 

Chemical  Corn/position  and  Properties. — According  to  the  anal] 
Doctor  Procter,  the  lobelia  contains  a  peculiar  alkaline,  acrid  principle, 
upon  which  its  active  properties  arc  supposed  to  depend.  Tins  is 
called  Lobeline.  Also  gum,  gallic  acid,  volatile  oil,  greenish  resin  or 
chlorophyle,  a  green,  fixed,  oily  matter,  salts  of  lime  and  potassa,  oxide 
of  iron  and  lignin. 

Physiological  Effects. — In  small  doses,  this  article  promotes  the 
secretions  of  the  gastro-puhnonary  tissues  and  at  the  same  time  affects 
the  nervous  system  as  a  narcotic.  In  larger  doses,  it  proves  emetic, 
and  its  operation  is  accompanied  with  copious  secretion  from  the  mouth 
and  fauces  and  general  relaxation.  In  still  larger  doses,  it  acts  as  a 
poison,  producing  great  anxiety  and  distress,  excessive  prostration,  con- 
vulsions, and  finally  death. 

From  the  preceding  account  of  its  effects,  the  indication  for  its  use  is 
obvious.  It  may  be  resorted  to  whenever  it  is  desirable  to  produce  an 
emetic  effect  and  at  the  same  time  free  secretion  from  the  gastro-pul- 
monary  tissue,  and  to  make  an  impression  on  the  nervous  system  with 
the  view  of  causing  relaxation. 

By  many  physicians  the  lobelia  is  looked  upon  as  a  dangerous  re- 
medy, and  its  use  has  been  accordingly  proscribed  by  them  in  all  cases. 
This  is  certainly  going  too  far.  If  imprudently  used,  it  is  unquestion- 
ably a  most  dangerous  remedy,  and  in  the  hands  of  empirics  it  has  been 
the  cause  of  melancholy  and  fatal  results.  The  same,  however,  may  be 
said  of  many  other  remedies  in  common  use.  This,  therefore,  is  no 
valid  objection  to  the  cautious  and  prudent  use  of  it.  The  testimony 
of  many  highly  respectable  practitioners  has  certainly  established  the 
fact  that,  if  properly  exhibited,  it  is  both  a  safe  and  valuable  remedy. 

Forms  of  Administration. — 1.  Powder. — This  is  probably  the  best 
form  in  which  it  can  be  used  as  an  emetic.  It  may  be  given  in  syrup 
or  made  into  pills.  The  average  dose  for  an  adult  is  from  ten  to 
twenty  grains,  which  may  be  repeated  in  half  an  hour,  if  necessary. 

2.  Tincture. — This  is  prepared  by  digesting  two  ounces  of  lobelia  in 
two  pints  of  diluted  alcohol,  for  ten  days,  and  then  straining.  Of  this 
half  an  ounce  .is  a  dose  as  an  emetic.  To  produce  simply  the  antispas- 
modic and  expectorant  effect,  one  or  two  drachms  may  be  given  evejy 
two  or  three  hours ;  to  a  child,  five  to  twenty  drops. 


sinapis  {mustard). 

Of  this  there  are  two  species — sinapis  nigra  and  sinapis  alba.  The 
sinapis  nigra  is  a  plant  three  or  four  feetThigh,  with  wide  spreading 
branches.  The  sinapis  alba  is  rather  smaller.  They  derive  their  names 
from  the  color  of  the  seeds.     Both  plants  are  natives  of  Europe,  but 


90  MATEBIA   MEDICA   AND   THEEAPEUT1CS. 

cultivated  in  this  country.  The  seeds  of  the  hlack  mustard  are  much 
smaller  than  those  of  the  white.  They  are,  however,  analogous  in  their 
properties  and  are  used  indiscriminately.  In  their  entire  state,  these 
seeds  have  no  smell,  but  when  bruised  have  a  peculiar  and  penetrating 
odor.     The  black  is  much  more  pungent  than  the  white. 

Mustard  is  a  powerful  stimulant  to  the  stomach  and  the  whole  sys- 
tem. In  small  doses  it  excites  the  stomach  and  promotes  digestion. 
In  larger  doses,  it  excites  vomiting,  and  in  still  larger  it  acts  as  an  irri- 
tant, causing  vomiting,  purging,  and  inflammation  of  the  stomach  and 
bowels.  When  used  as  an  emetic,  it  is  only  suited  to  cases  jn  which 
there  is  great  torpor  of  the  stomach,  and  where  that  organ  requires  to 
be  powerfully  stimulated,  such  as  cases  of  narcotic  poisoning. 

Mode  of  Administration. — From  a  tea-spoonful  to  a  table-spoonful  of 
the  flour  of  bruised  mustard  in  a  tumbler  of  water.  • 


anthemis  nobilis    {chamomile). 

This  is  a  native  of  Europe  growing  all  over  the  continent  and  in  Eng- 
land. From  the  large  quantities  of  it  which  are  used,  it  has  been  made 
an  object  of  cultivation  in  that  country,  and  most  of  what  is  used  in 
medicine  is  raised  by  the  growers  of  medicinal  plants.  The  part  used  is 
the  flower,  and  by  cultivation  these  become  double,  and  in  this  state  are 
generally  preferred.  What  is  used  in  this  country  is  generally  obtained 
from  England  and  Germany. 

Chamomile  flowers  have  a  strong  and  fragrant  smell,  and  a  bitter,  aro- 
matic taste.  The  best  are  those  which  are  large  and  of  a  whitish  color. 
By  long  keeping  they  lose  much  of  their  activity.  They  contain  a 
volatile  oil,  bitter  extractive,  and  tannic  acid. 

Effects. — Chamomile  is  an  aromatic  bitter  tonic,  and  it  is  only  when 
given  in  a  certain  way  that  it  proves  emetic.  This  is  in  the  form  of 
warm  infusion  and  taken  in  considerable  quantity —  §  ss  to  a  pint  of 
boiling  water.  It  is  mild  in  its  action,  and  is  chiefly  used  to  aid  the 
operation  of  other  emetics. 


TURPETH    MINERAL. 

This  is  the  hydrargyri  sulphas  flavus.  It  was  formerly  much  used, 
but  has  been  of  late  pretty  generally  discarded.  Still  it  is  a  powerful  and 
in  certain  cases  a  valuable  emetic,  especially  in  croup  and  cynanche 
maligna.  It  will  sometimes  act  well  in  cases  where  other  emetics  fail  to 
operate  or  run  off  by  the  bowels.  It  often  produces  very  copious  secre- 
tion from  the  fauces. 

Dose  three  grains. 


EMETICS.  01 

COMBINATION    OF    EMETICS. 

Emetics  are  combined  either,  First,,  to  increase  their  efficiency  by 
securing  the  effects  of  different  agents,  e.g.  tartar  emetic  with  ipecacu- 
anha. Ipecacuanha  is  limited  in  its  action  to  the  stomach.  Tartar 
emetic  affects  the  duodenum,  liver,  &c.  By  uniting  the  two,  we  secure 
the  prompt  and  certain  action  of  the  vegetable  with  the  greater  power 
of  the  mineral  emetic. 

Second,  To  modify  the  effects  of  one  remedy  by  the  other,  e.g.  Squill, 
though  it  promotes  secretion  powerfully,  is  at  the  same  time  stimulating; 
this  latter  quality  is  corrected  by  antimony ;  and,  on  the  other  hand, 
the  depressing  effects  of  antimony  are  moderated  by  the  squills.  Hence 
the  great  value  of  Coxe's  hive  syrup,  in  which  both  these  emetics  are 
united  with  senega. 

[This  preparation  has  gone  very  much  out  of  vogue,  and  is,  I  think, 
of  little  value. — Ed.] 


CATHAKTICS, 


Cathartics  are  defined  to  be  "those  medicines  which  quicken  or 
increase  the  evacuations  from  the  intestines;  or  which,  when  given  in  a 
certain  dose,  produce  purging."* 

In  relation  to  this  definition  the  same  remarks  may  be  made  which 
were  applied  to  emetics.  As  a  simple  definition  of  the  term  cathartic  it 
is  very  correct.  Purging,  however,  is  only  one  of  the  effects  of  these 
articles.  They  produce  a  great  number  of  others,  all  of  which  are  neces- 
sary to  be  taken  into  view  for  the  purpose  of  justly  appreciating  their 
operation  on  the  living  system.  In  treating  of  this  class  of  agents, 
I  shall  observe  the  same  order  which  was  adopted  when  discussing  the 
subject  of  emetics. 

1. OF  THE  ORGANS  IMMEDIATELY  ACTED  UPON  BY  CATHARTICS. 

These  are  the  intestines,  the  liver,  and  the  pancreas. 

The  Intestines.— -These  form  a  continued  canal  from  the  pylorus  or 
lower  orifice  of  the  stomach  to  the  anus.  The  whole  length  is  about 
six  times  that  of  the  body.  From  this  simple  fact  some  idea  may  be 
formed  of  the  extent  of  surface  upon  which  the  immediate  impression  of 
cathartics  is  made.  These  intestines  are  divided  into  the  small  and  the 
large,  differing  from  each  other  in  a  number  of  important  particulars. 
The  small  intestines  are  about  four  times  as  long  as  the  large ;  they 
have  three  coats  or  coverings — the  external  or  serous  covering,  the  mid- 
dle or  muscular,  and  the  internal  or  mucous  lining,  all  united  together 
by  intermediate  cellular  tissue.  Of  these,  the  two  last  are  especially 
important,  as  connected  with  the  operation  of  cathartics.  The  muscu- 
lar coat  is  made  up  of  two  sets  of  fibres,  one  longitudinal,  the  other 
circular.  By  a  regular  series  of  contractions  of  these  fibres  from  above 
downwards  (the  one  set  shortening,  and  the  other  contracting  the  canal), 
there  is  a  motion  produced  in  the  intestines  which  is  called  the  peri- 
staltic motion,  and  by  means  of  which  the  contents  of  the  intestines  are 
propelled  downwards.  In  the  large  intestines,  especially  the  colon,  this 
coat  assumes  a  different  character.     The  longitudinal  fibres  here  are 

*  Murray. 


CATHAKTIC8.  03 

collected  into  three  bands,  which  are  called  ligaments  of  the  colon.  At 
the  same  time,  the  circular  fibres  are  also  formed  into  bands,  mor< 
numerous  but  equally  distinct.  In  consequence  of  this,  in  a  great  num- 
ber of  places,  the  intestine  consists  only  of  the  serous  and  mucous  coats. 
These  places  between  the  muscular  fibres  bulge  out  and  arc  formed  into 
distinct  cavities,  which  arc  termed  the  cells  of  the  colon.  In  consequence 
of  this  organization,  the  descent  of  the  feces  is  rendered  more  gradual  ; 
and  when  the  action  of  the  canal  becomes  torpid,  they  do  great  mischief 
by  retaining  the  contents.  The  peristaltic  action  in  the  large  intestines 
is  much  less  powerful  than  in  the  small ;  on  the  other  hand,  however, 
they  enjoy  the  benefit  of  greater  pressure  from  the  abdominal  parictes 
— the  whole  length  of  the  colon  being  contiguous  to  them.  In  the 
inner  lining  of  the  intestines  is  a  mucous  tissue.  It  is  plentifully  sup- 
plied with  blood-vessels  and  mucous  follicles,  from  which  is  poured  out 
the  mucus  which  lines  the  whole  tract  of  intestines.  The  fluids  secreted 
and  poured  into  the  intestines  are  an  aqueous  or  serous  fluid  from  the 
exhaling  vessels — mucus,  bile,  and  the  pancreatic  fluid.  After  this  sim- 
ple view  of  the  construction  and  function  of  these  organs  we  shall  be 
better  able  to  understand  the  precise  effects  of  cathartics  upon  them. 


II. OF    THE    EFFECTS    OF    CATHARTICS. 

When  a  cathartic  is  taken,  the  organ  immediately  affected  is  the 
stomach,  and  the  first  effect  is  a  disgust  for  food  ;  frequently  nausea 
ensues,  and  sometimes  actual  vomiting.  If  this  takes  place,  the  medi- 
cine may  be  ejected,  and  no  other  effect  produced,  the  stomach  and 
other  organs  returning  in  a  short  time  to  their  natural  state.  If  the 
medicine  be  retained,  in  about  an  hour  (more  or  less,  according  to  cir- 
cumstances) an  uneasy  sensation  is  felt  in  the  abdomen,  which  increases 
gradually,  and  sometimes  amounts  to  pain.  An  increase  of  inter- 
nal heat  now  takes  place,  accompanied  with  borborygmus,  and  a  feeling 
as  if  the  lower  part  of  the  abdomen  were  swelled.  At  the  time  these 
sensations  are  experienced,  the  pulse  becomes  small,  and  a  slight  sense 
of  coolness  is  felt  over  the  surface.  In  a  short  time,  however,  the  pulse 
becomes  quicker  and  more  frequent ;  animal  heat  is  developed,  and  the 
skin  becomes  dry,  and  warm.  During  this  period,  colicky  pains  are  felt, 
and  evacuations  now  take  place  from  the  bowels,  which  are  repeated 
more  or  less  frequently  according  to  the  activity  of  the  purge  and  the 
condition  of  the  intestinal  canal.  Not  merely  the  number,  but  the  size 
is  well  as  quality  of  the  evacuations,  differ  greatly  according  to  circum- 
stances. 

The  length  of  time  which  a  purge  takes  to  complete  its  operation  is 
from  six  to  eight  hours ;  in  this  respect,  however,  there  is  considerable 


94  MATERIA   MEDICA   AND   THERAPEUTICS. 

difference,  according  to  the  article  used.  Some  take  even  longer  time, 
say  twelve  hours ;  while  others  again  act  in  three,  four,  or  less. 

After  the  operation  of  medicine  the  patient  is  generally  left  in*  a  state 
of  lassitute  and  heaviness,  sometimes  with  a  tendency  to  sleep. 

Such  are  are  the  ordinary  sensible  effects  of  a  cathartic.  To  understand 
more  fully  the  changes  which  the  organs  and  the  system  at  large  undergo 
during  this  process,  it  will  be  necessary  to  analyse  the  foregoing  effects 
a  little  more  in  detail.  In  doing  this  I  shall  pursue  the  same  order  as 
in  emetics. 

1.  The  first  effect  of  Cathartics  is  to  produce  a  peculiar  action  hi  the 
mucous  membrane  lining  the  intestinal  canal.  This  is  accompanied  with 
a  determination  of  blood  to  the  part,  and  augmented  sensibility.  To 
these  are  owing  the  sense  of  heat  and  swelling  which  is  one  of  the  first 
effects  of  this  class  of  remedies.  The  action  thus  excited  by  cathartics 
is  by  no  means  uniform.  According  to  the  article  used,  it  differs  mate- 
rially in  a  great  number  of  respects.  In  some  cases  it  is  mild  in  degree, 
and  transient  in  duration.  In  other  cases  it  is  so  decided  as  to  produce 
irritation,  and  even  actual  inflammation.  In  some  cases  this  action  is 
extended  to  the  whole  intestinal  tract,  while  in  others  it  is  limited  to 
particular  portions.  From  experiments  made  upon  living  animals,  it 
would  appear  that  the  _parts_  of  the  intestinal.  ca„nal . which  are  principally 
acted  upon  by  purgative  medicines  are  the  duodenum,  the  colon,  and 
the  rectum.  In  persons  who  have  died  shortly  after  taking  drastic 
purges  those  parts  have  been  found  in  a  state  of  inflammation.  The 
reason  of  this  probably  is,  that  the  jejunum  and  ilium,  from  the  fact  of 
their  being  loose  and  floating,  are  enabled  to  propel  the  medicines  more 
quickly  through  them,  and  in  this  way  lessen  their  action.  The  duo- 
denum, colon,  and  rectum  on  the  other  hand  are  fastened  down. 

2.  The  next  effect  of  Cathartics  is  to  cause  secretion  from  the  mucous 
membrane  of  the  intestines.  This  is  sometimes  the  result  of  the  above 
described  irritation  ;  but  most  cathartics  operate  in  a  different  and  purely 
physical  way,  by  what  is  called  endosmosis  and  exosmosis.  With  the 
laws  regulating  these  you  are  probably  familiar,  and  thus  prepared  to 
understand  how,  if  a  saline  solution  be  introduced  into  the  intestines,  it 
has  an  influence  on  the  blood-vessels,  which  varies  according  to  the 
strength  of  the  solution.  If  it  be  somewhat  concentrated,  the  effect  of 
its  proximity  to  the  blood-vessels  will  be  to  cause  the  exosmose  of  the 
serum  to  exceed  the  endosmose.  The  current  will  be  strongest  from 
the  blood-vessels  into  the  intestine,  and  the  saline  solution  will  be  diluted 
to  near  the  standard  of  the  blood.  If,  on  the  contrary,  the  saline  solu- 
tion is  very  weak,  its  specific  gravity  below  that  of  the  serum  of  the 
blood  (1025"30),  the  current  will  be  reversed  and  endosmosis  will  take 
place,  the  saline  solution  will  flow  into  the  vessels,  in  other  words  it  will 
be  absorbed. 


CATHARTIC'S.  05 

It  is  in  this  way  that  the  salines  act  as  purgatives. 

3.  Cathartics  increase  the  natural  action  of- the  museulaP  M&4  of  the 
intestines.  From  the  Intimate  connexion  existing  between  the  mu< 
lining  and  the  muscular  coat  of  the  intestines,  the  impression  made  upon 
the  former  is  speedily  transmitted  to  the  latter.  In  this  way,  as  well  as 
from  the  stimulus  of  the  various  matters  secreted  in  the  intestini  -,  the 
muscular  tissue  is  excited  to  increased  and  sometimes  irregular  action. 
To  tli is  are  owing  the  colicky  pains  which  are  felt  during  the  operation 
of  cathartics.  In  the  impression  which  is  thus  made  upon  the  muscular 
coat  of  the  intestines,  there  is  a  great  difference  among  cathartic  agents, 
some  acting  powerfully  in  this  way  without  causing  any  free  secretion 
from  the  mucous  surface. 

4.  Cathartics  promote  secretion  from  the  liver.  [This  they  do  In- 
special  action  of  their  molecules  upon  the  liver  after  their  absorption. — 
Ed.]  In  the  power  which  they  possess  of  thus  calling  the  liver  into 
action  there  is  a  marked  difference  between  cathartics.  Calomel,  for 
example,  possesses  it  in  an  eminent  degree,  while  the  neutral  salts  are 
destitute  of  it. 

5.  Cathartic*  increase  the  secretion  from  the  paMcreas.  This  is  nearly 
as  certain  as  their  operation  on  the  liver,  although  from  the  character 
of  the  secretion,  &c,  we  cannot  have  the  same  demonstrative  proof  of  it. 
It  is  effected  in  the  same  way  as  in  the  case  of  the  liver. 

6-  Actual  evacuation  of  the  contents  of  the  intestines  is  the  last  effect 
produced.  This  is  accomplished  in  the  following  way.  The  rectum  first 
contracts;  this  is  immediately  followed  by  a  similar  action  of  the  dia- 
phragm and  abdominal  muscles.  By  this  combined  pressure  downwards, 
the  levator  ani  is  elongated,  and  the  resistance  of  the  sphincters  is  over- 
come and  evacuation  takes  place.  When  the  freces  have  been  voided, 
the  diaphragm  rises  and  the  abdominal  muscles  become  relaxed — the 
levator  ani  retraets  the  intestine,  and  it  is  again  closed  by  the  sphincter: 
During  this  process  the  lungs  are  filled  with  air,  and  expiration  is 
prevented. 

From  the  foregoing  analysis  it  appears  that  purgation  does  not  con- 
sist simply  in  evacuating  the  contents  of  the  intestinal  canal.  It  sets 
into  more  or  less  active  operation  a  large  extent  of  mucous  tissue,  and  a 
number  of  important  glands.  It  is  only  by  bearing  this  in  mind  that 
anything  like  a  just  conception  of  the  influence  of  cathartics  upon  the 
system  can  be  formed. 

Of  the  Remote  Effects  of  Cathartics. — These  are  various  and 
important. 

(a.)  On  the  Mucous  System. — A  very  large  extent  of  this  system 
vie.  from  the  stomach  to  the  rectum,  is  directly  acted  upon  by  cathartic 
medicines;  and  the  effect  here  is,  as  already  stated,  to  iucrease  exhala- 


96  MATEEIA   MEDICA   AND   THERAPEUTICS. 

tion  and  secretion.  From  the  great  determination  of  fluid  which  thus 
takes  place  to  the  intestines,  the  secretions  from  other  portions  of  the 
mucous  system,  instead  of  being  increased,  are  diminished.  This  is 
particularly  the  case  with  the  part  of  it  which  lines  the  mouth  and 
oesophagus.  Hence  it  is,  that  during  the  operation  of  cathartics, 
the  mouth  becomes  dry,  and  thirst  is  created.  A  similar  effect  is 
also  produced  upon  the  membrane  lining  the  trachea  and  bronchial 
tubes. 

(b.)  On  the  Brain  and  Nervous  System. — The  effect  of  cathartics  is 
to  impair  temporarily  the  energy  of  the  brain  and  nervous  system. 
Debility  ensues,  the  intellectual  functions  are  not  performed  with  vigor 
or  ease,  and  there  is  a  great  disposition  to  drowsiness  and  sleep.  All 
this  is  owing  to  the  concentration  of  vital  energy  in  the  intestinal 
canal,  depriving  the  brain  of  its  due  share — to  the  great  determination 
of  blood  to  this  part, — as  well  as  to  the  direct  debility  induced  by  the 
evacuations  which  cathartics  produce. 

(c.)  On  the  Vascular  System. — The  first  eifect  of  cathartics  on  the 
circulation  is  to  produce  an  unequal  distribution  of  blood  throughout 
the  system.  In  consequence  of  the  action  excited  in  the  intestines,  a 
great  determination  of  blood  takes  place  to  these  organs,  and,  as  a 
matter  of  course,  the  relative  proportion  in  other  parts  of  the  system 
must  be  diminished.  Hence  it  is,  that,  during  the  operation  of  these 
agents,  the  pulse  becomes  more  frequent  and  smaller  than  natural,  and, 
when  colicky  pains  come  on,  unequal,  just  as  in  enteritis  and  in  dysen- 
tery the  pulse  is  small  and  frequent.  After  the  operation  of  the 
cathartic  is  completely  over,  and  the  temporary  determination  to  the 
intestines  has  subsided,  the  blood  again  is  uniformly  distributed 
throughout  the  system — the  pulse  lessened  both  in  force  and  frequency. 
This  is  evidently  the  result  of  the  depletion  which  the  system  under- 
goes, and  is  in  proportion  to  the  number  and  copiousness  of  the 
evacuations. 

During  the  act  of  passing  the  feces,  from  the  muscular  contraction 
and  straining  which  take  placeT  there  is  a  temporary  interruption  to 
the  free  and  equal  circulation  of  the  blood.  In  degree  this  is  always  in 
proportion  to  the  difficulty  attending  the  operation.  Hence  it  is  that 
old  persons  whose  bowels  are  torpid  sometimes  die  of  apoplexy  while 
straining  at  stool.*  On  the  blood  itself,  the  effect  of  cathartics  is,  by 
taking  from  it  through  the  intestinal  capillaries  a  large  amount  of  its 
serum,  to  alter  the  quality  of  the  general  mass,  by  compelling  (so  to 
speak)  the  vessels  to  supply  their  loss  from  the  fluids  that  may  be 
within  their  reach.      It  is  in  this  way  that  cathartics  promote  absorp. 

*  Mr.  Hennen  says,  "  I  scarcely  recollect  a  situation  in  whieh  bleeding  after 
amputations,  especially  of  the  lower  extremities,  occurs  more  frequently  than  in  the 
act  of  passing  fsecal  accumulations." — P.  210. 


CATHARTICS.  ft? 

tion,  and  aid  in  the  removal  of  dropsical  accumulations.  They  may 
promote  absorption  in  another  way.  When  the  capillary  Bystem  is 
inflamed  and  congested,  it  may  from  that  cause  be  unable  to  perform 
its  function  of  absorption.  Cathartics,  by  removing  tlie  congestion  or 
inflammation,  may  restore  to  the  vessels  the  power  they  had  lost. 

((/.)  On  the  Cutaneous  System. — Between  the  skin  and  mucous 
membrane  lining  the  alimentary  canal,  there  is  not  merely  a  great 
analogy  in  structure,  but  great  sympathy  of  action.  Illustrations  of 
this  we  see  continually  in  the  occurrence  of  cutaneous  affections  from 
disorder  of  the  stomach  and  bowels.  Hence  the  skin  is  powerfully 
influenced,  when  so  extensive  an  action  is  excited  in  so  large  a  portion 
of  the  mucous  membrane  as  is  the  case  during  the  operation  of  cathar- 
tics. Accordingly,  under  catharsis,  the  skin  becomes  dry  and  cool, 
and  perspiration  is  suppressed.  When  the  operation  ceases,  the  func- 
tion of  the  skin  is  again  restored.  This  is  the  effect  of  a  single  cathartic. 
When  frequently  repeated,  the  effect  is  more  permanent,  and  new 
action  is  eventually  set  up  in  the  extreme  vessels  of  the  surface.  It  is 
by  this  alterative  effect,  as  well  as  by  the  constant  diversion  of  action 
from  the  surface  to  the  intestines,  that  cathartics  prove  so  beneficial  in 
many  cutaneous  affections. 

Of  the  Circumstances  Modifying  the  Effects  of  Cathartics. — 
(a.)  Age. — As  a  general  rule,  cathartic  medicines  operate  much  more 
readily  at  an  early  period  of  life  than  they  do  afterwards.  This  is 
owing  to  the  greater  sensibility  of  the  intestinal  canal  at  this  period. 
Even  without  taking  medicines,  children  have  a  more  frequent  call  to 
evacuate  the  faeces  than  adults.  A  healthy  child  has  generally  a 
couple  of  loose  light-colored  evacuations  a  day.  In  giving  cathartics, 
therefore,  to  children,  the  milder  articles  are  preferred.  From  the  o;reat 
sensibility  of  the  intestinal  canal  as  well  as  of  the  whole  nervous  svstem 
in  children,  active  cathartics  are  apt  to  produce  the  most  unpleasant 
consequences.  In  some  cases  fatal  convulsions  have  thus  been  induced, 
while  in  others,  especially  if  the  purging  has  been  protracted,  general 
and  fatal  exhaustion  has  been  the  consequence.  Notwithstanding  this 
general  sensibility  of  the  intestines  of  children,  there  is  a  condition  of 
these  organs  which  enables  them  to  bear  larger  proportionate  doses  of 
some  cathartic  medicines  than  adults.  In  children  there  is  a  great 
tendency  to  the  secretion  of  mucus  in  the  intestines.  This  becomes 
viscid,  and  adheres  to  the  inner  lining  of  these  organs,  and  in  this  way 
interferes  with  the  action  of  cathartics.  As  we  advance  in  years,  the 
intestines,  in  consequence  of  their  repeated  stimulation,  have  their 
sensibility  impaired,  and  their  contractile  power  proportionably  lessened. 
The  natural  secretions,  too,  of  the  mucous  membrane  become  less 
copious,  the  bowels  sluggish,  and  the  stools  more  scanty  and  hardened. 


98  MATERIA    MEDICA    AND.  THERAPEUTICS. 

Old  persons  seldom  have  an  evacuation  oftener  than  once  in  two  or 
three  days.  From  this  condition  of  the  intestines,  it  happens  that 
cathartics  produce  less  effect  upon  old  persons,  and  must  be  used  in 
larger  doses  and  the  more  active  articles  selected. 

(b.)  Sex. — From  the  greater  delicacy  of  the  female  constitution  and 
from  their  nervous  temperament,  equal  doses  of  the  same  medicine  will 
be  more  apt  to  produce  violent  effects  in  them  than  males.  This  is  the 
case  with  regard  to  cathartics,  and  especially  the  more  active  ones. 
During  the  state  of  pregnancy,  cathartics  should  be  used  with  a  certain 
degree  of  caution,  inasmuch  as  their  use  may  be  followed  by  premature 
action  of  the  uterus  and  a  consequent  expulsion  of  the  foetus.  This  is 
owing  to  the  sympathy  existing  between  the  intestinal  canal  and  the 
uterus,  and  it  is  more  especially  apt  to  occur  in  irritable  temperaments  and 
those  who  are  prone  to  abortion.  It  is  most  apt  to  follow  the  use  of 
such  cathartics  as  produce  much  irritation  about  the  rectum.  In  preg- 
nancy, therefore,  articles  of  this  kind  should  be  carefully  avoided  and 
the  milder  ones  always  selected.  It  is  not  to  be  inferred  from  this,  how- 
ever, that  cathartics  are  always  dangerous  remedies  during  pregnancy. 
On  the  contrary,  in  cases  of  acute  disease,  very  active  articles  may  and 
have  been  given  not  merely  with  impunity  but  with  benefit.  During 
the  yellow  fever  of  1*793,  Dr.  Rush  states  that  he  had  recourse  to  the 
use  of  calomel  and  jalap  in  the  cases  of  several  pregnant  women,  who 
were  attacked  with  the  fever,  and  he  was  so  fortunate  as  not  merely  to 
save  his  patients,  but  to  do  it  without  producing  miscarriage.  In  one 
of  the  cases,  too,  the  female  had  miscarried  twice  before. 

(c.)  Climate. — As  a  general  rule,  active  cathartics  are  not  borne  so 
well  in  hot  climates  as  in  temperate  and  cold  ones.  This  is  owing  no 
doubt  to  the  greater  sensibility  of  the  mucous  membrane,  rendering  this 
part  of  the  system  more  liable  to  active  irritation.  Dr.  Rushenberger, 
surgeon  in  the  American  Navy,  remarked  during  a  cruise  of  the  United 
States  frigate  Brandy  wine,  in  the  Pacific  Ocean,  in  1826,  '7,  '8,  '9,  that 
the  soldiers  and  sailors  did  not  bear  the  operation  of  purging  as  well  in 
the  kot  latitudes  as  in  the  cold  and  temperate  ones.*  Independently, 
however,  of  mere  temperature,  there  appears  to  be  something  peculiar 
in  certain  regions  which  modifies  the  operation  of  cathartics. 

(d.)  Habits  and  Mode  of  Life. — All  debilitating  causes  acting  con- 
tinuously upon  the  system,  either  in  the  way  of  occupation  or  mode  of 
living,  have  a  direct  tendency  to  impair  the  capability  of  the  constitu- 
tion for  sustaining  the  action  of  powerful  cathartics.  Dr.  Ferriar  states 
that  the  natives  of  the  manufacturing  town  of  Manchester  bear  evacua- 
tions very  badly.  In  ordering  cream  of  tartar  in  cases  of  dropsy,  in  the 
Manchester  Infirmary,  he  found  that  the  patients  could  not  bear  the 

*  American  Journal  of  the  Medical  Sciences.     Yol.  vi.  p.  348. 


OATHABTTCS.  00 

same  quantities  which  are  prescribed  by  Dr.  Home  in  the  Royal  [nfirmary 
of  Edinburgh,  and  tbat  even  in  giving  the  ordinary  quantity,  cordials 
and  tonics  were  necessary  at  the  same  time.*  Literary  and  studious 
habits,  from  the  derangements  of  the  nervous  system  which  they  are  apt 
to  induce,  have  a  general  tendency  to  impair  the  power  of  the  constitu- 
tion to  sustain  active  purging.  In  all  the  cases,  however,  connected  with 
the  mode  of  life,  there  is  none  which  so  strikingly  modifies  the  effeel  of 
cathartics  as  intemperance.  Where  this  habit  has  been  long  persisted 
in  and  the  system  undermined  by  it,  active  purging,  like  bleeding  or 
tartar  emetic,  not  unfrequently  produces  exhaustion  and  death. 

(e.)  Frequent  Repetition. — As  in  the  case  of  all  other  medicines,  this 
modifies  very  strikingly  the  effect  of  cathartics.  In  some  cases  it  ren- 
ders the  bowels  preternaturally  irritable,  so  that  the  simplest  articles 
and  the  smallest  doses  will  excite  purging.  In  others,  again,  a  contrary 
effect  is  produced,  and  a  confirmed  habit  of  costiveness  induced.  In 
these  cases  the  difference  of  result  depends  altogether  upon  the  condition 
of  the  intestinal  canal,  and  the  precise  manner  in  which  the  purgation  is 
conducted.     [Much  depends  on  the  article  used.] 

(/.)  The  actual  condition  of  the  system  as  to  disease, — This  modifies 
in  a  most  important  manner  the  effect  of  this  class  of  remedies.  In  a 
state  of  health  they  produce  irritation  and  derangement  of  the  system ; 
in  disease  they  remove  it.  The  condition  of  the  vascular  system  modi- 
fies the  effect  of  cathartics.  In  a  full  plethoric  habit  generally  they 
never  operate  as  well  as  when  the  system  is  somewhat  reduced.  Hence 
in  such  cases  previous  blood-letting  always  facilitates  their  operation. 
Not  unfrequently  cases  are  occurring  in  which  after  the  most  active  articles 
fail  to  move  the  bowels,  they  yield  immediately  on  the  use  of  venesection. 
[This  is  especially  true  where  there  is  congestion  of  the  brain.]  The 
state  of  the  intestines,  too,  greatly  modifies  their  action.  In  some  cases, 
for  example,  these  organs  are  so  lined  with  viscid  mucus  as  that  the  most 
active  agents  make  no  impression  at  all.  The  state  of  the  brain  and 
nervous  system  also  greatly  modifies  the  action  of  these  agents.  In  apo- 
plexy and  hydrocephalus,  for  example,  the  torpidity  of  the  bowels  is  so 
great  that  the  most  active  cathartics  produce  little  or  no  effect.  Maniacs 
have  been  generally  supposed  to  be  in  a  great  measure  insusceptible  to 
the  action  of  ordinary  cathartics  ;  observations,  however,  on  a  large 
scale  have  shown  this  to  be  erroneous. 

Rules  to  be  observed  in  using  Cathartics. — 1 .  Given  on  an  empty  sto- 
mach cathartics  act  more  efficaciously  and  are  less  apt  to  be  rejected. 
[Aloes  is  an  exception  to  this  rule.  Aloetic  pills,  e.  g.  dinner  pills, 
are  best  taken  with  food. — Ed.] 

*  Medical  Histories  and  Reflections.     By  John  Ferriar.  il.D. — P.  xlv. 


100  MATERIA  MEDIC  A   AND   THERAPEUTICS. 

2.  Period  of  clay. — In  this  respect  different  articles  vary.  Some  are 
best  given  at  night,  others  in  the  morning. 

3.  Always  dilute  with  warm  gruel  as  soon  as  it  begins  to  operate. 
This  allays  irritation  and  promotes  secretion. 

4.  To  gain  full  effect  a  patient  to  be  kept  for  twenty-four  hours  on 
diluents. 

5.  Examine  the  evacuation. 

6.  Don't  be  satisfied  with  giving  a  purge — see  the  effect;  see  that  the 
effect  you  desired  to  produce  is  attained. 

Evacuations  produced  by  Cathartics. — These  differ  greatly  in  their 
number,  size,  and  quality,  according  to  the  article  which  may  be  used. 
The  first  evacuations  which  are  passed  are  made  up  of  the  fasces 
remaining  in  the  large  intestines  and  the  alimentary  substances  reduced 
to  chyme,  which  have  passed  the  digestive  organs  and  have  had  their 
progress  accelerated  by  the  action  of  the  medicine.  After  this  the 
evacuations  assume  a  different  appearance  and  become  more  liquid,  in 
consequence  of  the  different  fluids  secreted  into  the  intestinal  canal. 
Serum  is  poured  out  from  the  exhalants  of  the  inner  surface  of  the 
intestines ;  mucus  from  the  mucous  follicles ;  bile  from  the  liver ;  and 
pancreatic  juice.  In  addition  to  these  are  the  various  kinds  of  drink 
which  may  have  been  used  during  the  operation ;  of  these  various 
materials  are  made  up  the  evacuations,  differing  in  the  relative  propor- 
tions of  the  several  ingredients  according  to  the  particular  medicine 
used,  and  the  actual  condition  of  the  intestines  and  the  system  at  large. 
From  the  character  of  the  evacuations,  therefore,  it  may  be  inferred  what 
tissues  and  organs  have  been  particularly  acted  upon  by  the  medicine. 
If  they  are  watery,  the  exhalants  of  the  intestinal  canal  have  been  excited 
into  increased  secretion,  if  mucous,  the  mucous  follicles  have  been  acted 
upon,  if  bilious,  it  is  an  evidence  of  increased  secretion  from  the  liver. 
According  to  the  predominance  of  either  of  these  secreted  fluids,  and 
other  circumstances,  such  as  the  nature  of  the  food  which  may  have 
been  used,  &c,  the  evacuations  will  be  found  to  differ  in  their  consist- 
ency and  color.  For  the  purpose  of  forming  a  correct  opinion  in  relation 
to  the  evacuations,  it  is  important  to  be  familiarized  with  their  appear- 
ance in  a  state  of  health,  as  well  as  the  various  modifications  they  may 
undergo  from  articles  of  diet  and  medicine,  as  well  as  from  disease. 

A  perfectly  healthy  evacuation  has  a  color,  consistence,  size,  and  smell 
peculiar  to  itself,  and  which  can  be  better  learned  from  observation  than 
from  description.  In  morbid  states  of  the  intestinal  canal  they  assume 
a  great  variety  of  appearances.  In  jaundice  they  are  clay-colored.  In 
dysentery,  bloody,  mixed  with  pus,  mucus,  &c. 

Various  medicines  have  the  effect  of  altering  the  evacuations.  The 
use  oiiron  makes  them  black;  sulphur,  too,  darkens  them.    Hematoxylon 


CATHARTICS.  101 

makes  them  of  a  blood-red  cblor.     Senna  gives  them  a  greenish,  tinge ; 

calomel,  also,  frequently  renders  them  green. 

Food  and  drink,  too,  greatly  vary  tlie  appearance  of  the  evacuations. 
The  common  vegetable  tomato  turns  them  black;  spinach  makes  llicm 
green.     Claret  gives  them  a  peculiar  lake  tinge.* 

THERAPEUTICAL    EFFECTS. 

Various  modes  in  which  Cathartics  prove  Curative. — These,  as  they  lie 
at  the  foundation  of  their  use  in  different  diseases,  require  to  be  care- 
fully analysed. 

(a.)  Cathartics  jnove  Curative  by  simply  unloading  the  Intestinal 
Canal. — A  constipated  state  of  the  bowels,  accompanied  with  an  unna- 
tural accumulation  of  fajcal  matter  in  the  large  intestines,  interferes  in  a 
great  many  ways  with  the  healthy  action  of  the  different  organs  of  the 
human  body.  Not  merely  the  abdominal  organs,  but  every  other  part 
of  the  system,  is  directly  or  indirectly  affected  by  it.  To  remove  this, 
therefore,  in  every  disease  in  which  it  occurs,  is,  of  course,  a  leading 
indication  ;  and  this  is  to  be  accomplished  by  the  use  of  cathartic  agents. 

(b.)  By  making  a  new  and  peculiar  impression  upon  the  Mucous 
Membrane  of  the  Intestines,  altering  existing  action  and  -promoting  secre- 
tion.— The  interruption  in  the  natural  secretion  of  the  mucous  mem- 
brane of  the  intestinal  canal  is  a  constant  occurrence  in  diseased  condi- 
tions of  the  system,  and  the  restoration  of  these  secretions  is  one  of  the 
essential  means  of  cure.  By  the  use  of  appropriate  cathartics  this  is 
effected. 

(c.)  By  promoting  the  secretory  function  of  the  Liver. — In  a  great 
variety  of  diseases  the  liver  becomes  disordered  in  its  functions.  Not 
merely  the  quantity  of  bile  is  lessened,  but  the  character  of  it  is  very 
much  changed  from  its  natural  and  healthy  state.  Among  the  means 
calculated  to  correct  this  condition  of  the  liver,  cathartics,  and  especially 
calomel,  are  the  prominent  agents. 

(d.)  By  creating  a  new  action  in  the  Intestines,  and  keeping  up  a  de- 
termination of  fluids  to  this  part,  and  thus  relieving  other  parts  of  the 
system,  by  transferring  action  from  one  part  of  the  system  to  another. — 
In  this  way  cathartics  act  upon  the  principle  of  revulsion  or  counter- 
irritation,  and  they  thus  prove  eminently  beneficial  in  a  great  number 
and  variety  of  affections.  To  produce  this  effect  in  the  most  decided 
degree,  the  purgation  should  be  continued  for  a  suitable  length  of  time, 

*  Mr.  Hennen  states  that  "  by  the  use  of  lamego  and  other  deep-colored  wines 
of  Portugal,  the  stools  acquire  a  tinge  almost  approaching  to  black."  He  adds, 
"I  have  known  some  attempts  made  to  impose  upon  medical  men  by  persons  who 
have  been  acquainted  with  these  facts." — Military  Surgery,  p.  373. 


102  MATERIA' MEDIC  A   AND   THERAPEUTICS. 

and  such  cathartics  selected  as  are  capable  of  producing  a  decided 
impression  upon  the  intestinal  canal.  In  this  way  almost  every  organ 
and  tissue  in  the  body  may  be  indirectly  influenced  by  cathartics. 

(e.)  By  acting  as  simple  evacuants,  and  in  this  way  lessening  the 
quantity  of  circulating  fluids,  and  improving  the  action  of  the  Heart  and 
Arteries. — The  cathartics  best  calculated  to  produce  ThisTfFect  are 
those  which  act  powerfully  on  the  exhalants  of  the  intestinal  canal,  and 
cause  copious  watery  evacuations.  The  amount  of  effect  which  they 
are  capable  of  producing  in  this  way  must  appear  obvious,  if  we  reflect 
for  a  moment  on  the  extent  of  surface  upon  which  they  act,  and  the 
quantity  of  fluid  which  may  be  drained  from  the  system  through  their 
agency. 

(f.)  By  equalizing  the  Circulation. — This  effect  may  be  produced  in 
two  ways,  according  to  the  cause  producing  the  unequal  distribution  of 
blood.  In  some  cases,  this  is  owing  to  the  pressure  of  the  overloaded 
and  distended  intestines  upon  the  large  blood-vessels  of  the  abdomen, 
which  thus  mechanically  interferes  with  the  circulation  in  those  vessels, 
and  as  a  consequence  causes  congestion  about  the  head  and  chest. 
Cathartics,  by  simply  unloading  the  intestines,  remove  the  pressure,  and 
thus  relieve  the  obstructed  circulation.  In  other  cases,  the  unequal  dis- 
tribution of  blood  is  owing  to  undue  accumulations  in  particular  parts, 
in  consequence  of  inflammation  or  congestion.  Cathartics;  by  exciting 
an  action  in  the  intestinal  canal,  and  making  it  a  new  centre  of  afflux 
for  the  fluids  of  the  system,  divert  from  other  parts,  and  thus  equalize 
the  circulation. 

[(g.)  Cathartics  often  serve  a  most  important  purpose_a^depuratives, 
enabling  the  circulating  fluid  to  rid  itself  of  noxious  matters!  Hence 
their  utility  in  gout,  rheumatism,  and  other  diseases  dependent  on  the 
presence  of  noxious  matters  in  the  blood.] 


OF    THE    USE    OF    CATHARTICS    IX    PARTICULAR    DISEASES. 

There  is  no  class  of  medicinal  agents  more  generally  resorted  to,  or 
more  really  useful,  than  cathartics,  if  used  with  due  discretion.  To  a 
certain  extent,  they  may  be  rendered  available  in  almost  every  disease 
to  which  the  system  is  exposed.  The  very  fact,  however,  of  their  being 
so  generally  useful,  renders  them  liable  to  be  abused.  One  would  sup- 
pose that  the  opinion  was  entertained  by  many  that  purging  could 
never  do  harm,-  but  was  always  attended  by  beneficial  consequences. 
Hence  they  appear  to  be  prescribed  almost  as  a  matter  of  course,  with- 
out much  regard  to  the  existing  state  of  the  system,  or  to  the  important 
effects  which  these  agents  produce.  That  this  statement  is  by  no 
means  exaggerated  must  be  apparent  to  every  competent  and  attentive 


CATHARTICS.  108 

observer,  and  it  shows  the  necessity  of  establishing,  if  possible,  Borne  of 
the  leading  facts  and  fundamental  principles  by  which  the  use  of  th<  e 
agents  may  be  regulated.  This  I  sh;ill  attempt  in  the  following 
remarks. 

I.  Of  Fevers. — Without  entering  into  any  discussion  on  tin;  nature 
of  fever,  it  is  only  necessary  to  notice  some  of  the  prominent  phenomena 
attending  it,  for  the  purpose  of  elucidating  the  principles  upon  which 

cathartics  are  used. 

1.  In  fever,  it  is  often  observed  that  the  natural  peristaltic  motion  of 
the  bowels  is  impaired.  Hence  costiveness  is  a  prominent  symptom, 
and  the  contents  of  the  intestinal  canal  are  retained  a  much  longer 
period  than  they  should  be — and  being  so  retained,  they  necessarily  act 
as  a  cause  of  irritation,  and  thus  increase  the  general  febrile  symptoms. 

2.  It  is  observed  in  fever  that  the  function  of  the  mucous  lining 
of  the  intestines  becomes  disordered.  Hence,  the  secretions  of  this  sur- 
face are  lessened  in  quantity  and  altered  in  character — in  some  cases 
becoming  highly  vitiated  and  unnatural  in  their  appearance. 

'3.  It  is  observed  that  the  functions  of  the  liver  are  frequently  dis- 
ordered, and  the  liver  itself  congested.  The  quantity  of  bile  is  greatly 
diminished,  and  frequently  much  altered  in  its  character. 

4.  The  abdominal  viscera  are  generally  more  or  less  crowded  with 
blood,  and  their  secretory  functions  more  or  less  impaired.  Now,  to 
obviate  and  correct  these  conditions  of  the  abdominal  organs,  cathartics 
are  the  remedies  resorted  to,  and  they  operate  in  the  following  manner. 
They  evacuate  the  contents  accumulated  in  the  intestines — they  pro- 
mote the  secretions  of  the  mucous  lining  of  the  intestines — they  excite 
the  liver  and  promote  the  secretion  of  bile — and  lastly,  they  aid  in 
restoring  the  secretions  of  the  other  abdominal  viscera.  In  consequence 
of  these  local  effects,  others  of  a  general  nature  ensue.  The  circulation 
becomes  more  free  and  uniform,  the  blood  is  more  equally  distributed 
and  general  excitement  is  diminished. 

In  endeavoring  to  accomplish  these  objects  by  cathartics,  there  are 
two  things  specially  to  be  regarded.  One,  the  proper  selection  of  cathar- 
tics, the  other  the  particular  condition  of  the  mucous  lining  of  the  intes- 
tinal canal.  It  has  already  been  stated  that  cathartics  differ  greatly ; 
some  act  mildly,  others  produce  great  local  irritation ;  some  promote 
secretion,  others  are  in  a  great  measure  destitute  of  this  power.  Now 
the  cathartics  which  are  required  in  fever,  are  such  as  will  evacuate  the 
bowels,  restore  abdominal  secretion,  and  at  the  same  time  produce  as 
little  local  irritation  as  possible.  All  drastic  cathartics  are  therefore 
improper;  they  have  a  tendency  to  create  local  inflammation  of  the 
intestines,  and  in  this  way  aggravate  the  general  febrile  commotion. 
Among  the  cathartics  best  suited  to  fever,  calomel  takes  the  lead.  It 
promotes  in  a  manner  peculiar  to  itself  hepatic  and  intestinal  secretion, 


104  MATERIA    MEDICA    AND   THERAPEUTICS. 

■while  it  produces  little  or  no  local  irritation.  As  an  adjunct  to  calomel, 
castor  oil  is  invaluable.  It  evacuates  most  thoroughly  the  contents  of 
the  bowels  and  has  a  tendency  to  allay  irritation.  In  addition  to  these, 
the  saline  cathartics,  jalap,  rhubarb,  and  magnesia,  may  be  used  with 
safety  and  advantage. 

With  regard  to  the  condition  of  the  mucous  lining  of  the  intestines,  it 
is  to  be  recollected  that  in  fever  it  is  frequently  the  seat  of  inflammation, 
and  when  this  is  the  case,  active  purging  ought  to  be  avoided.  Even 
this,  however,  should  not  preclude  the  occasional  use  of  calomel,  and  the 
regular  evacuation  by  mild  means.  As  fevers  differ  in  their  phenomena, 
the  use  of  cathartics  as  well  as  of  all  other  agents  must  evidently  be 
very  much  modified  by  this  circumstance.  For  the  purpose  of  illustrat- 
ing this,  let  us  notice  briefly  the  more  striking  varieties  of  fever. 

(a.)  Intermittent  Fever. — The  essential  means  of  cure  in  this  form 
of  fever  are  tonics  [anti-periodics]  of  various  kinds,  administered  during 
the  intermission,  with  the  view  of  preventing  the  return  of  the  parox- 
ysms. For  the  safe  and  effective  use  of  these  agents,  however,  the  sys- 
tem must  be  properly  prepared,  and  among  the  agents  used  for  this 
purpose,  cathartics  are  the  most  efficient.  The  reasons  of  this  will  be 
apparent  from  the  following  considerations.  From  the  nature  of  the 
convulsion  through  which  the  sj'stem  goes  during  a  paroxysm  of  this 
form  of  fever,  it  is  evident  that  a  congestion  of  blood  must  take  place  in 
the  abdominal  viscera.  The  necessary  consequence  of  such  congestion 
is  a  derangement  of  function  in  the  parts  concerned,  showing  itself  in 
disordered  action  of  the  stomach,  liver,  and  bowels ;  the  tongue  is  furred, 
the  stomach  is  nauseated,  and  the  bowels  constipated.  In  the  collapse, 
of  the  system  which  takes  place  during  the  sweating  stage,  although 
the  congestion  is  partially  and  sometimes  entirely  relieved,  yet  this  dis- 
ordered condition  of  the  digestive  organs  remains  behind  to  a  greater  or 
less  degree.  Now,  if  in  this  state  of  things  tonics  [anti-periodics]  be  at 
once  resorted  to,  it  will  be  found  not  merely  that  they  are  uncertain 
in  their  effects,  but  they  frequently  render  permanent  the  periodical 
congestion  which  takes  place  during  the  paroxysms.  To  obviate  all 
this,  suitable  preliminary  evacuation  is  required.  The  best  cathartics 
for  this  purpose,  are  such  as  will  promote  hepatic  and  intestinal  secre- 
tion without  producing  much  irritation.  The  best  articles  to  accom- 
plish these  objects  are  calomel  followed  by  castor  oil,  or  calomel  and 
jalap  in  combination.  In  ordinary  cases,  and  when  the  disease  is  taken 
in  its  commencement,  a  single  cathartic  will  answer  every  purpose. 
When,  however,  the  paroxysms  have  been  continued  for  some  time, 
where  there  is  great  bilious  derangement,  fulness  of  the  abdomen,  foul 
tongue,  &c,  repeated  purgation  may  be  necessary  before  tonics  will  pro- 
duce their  effects. 

In  intermittent  fever,  then,  cathartics  are  to  be  considered  merely  as 


CATIIAJflK'S.  I').r> 

preliminary  agents  to  bring   the  system,   and  especially  the  digi  fcive 

organs,  into  a  condition  appropriate  to  the  use  of  tonics  [anti-pcriodics]. 

The  best  period  for  giving  cathartics  is  during  the  intermission. 

(/>.)  Remittent  Fever. — Here  the  use  of  cathartics  is  still  more  impe- 
ratively called  for.  In  this  form  of  fever  the  congestions  of  the  abdomi- 
nal  viscera  are  of  a  more  permanent  character  than  the  intermittent. 
In  consequence  of  this  the  functional  derangements  of  the  liver,  stomach, 
and  intestines  are  more  marked,  and  it  is  for  the  improvement  and  cor- 
rection of  tli  esc  that  cathartics  are  so  essential,  and  1  he y  must  be  repeated 
according  to  circumstances  until  these  objects  are  accomplished.  The 
articles  most  useful  here  are  calomel  followed  by  castor  oil,  calomel  and 
jalap,  the  saline  cathartics,  and  magnesia.  In  this  form  of  fever,  inflam- 
mation of  the  stomach  and  bowels  is  not  an  uncommon  occurrence,  and 
when  this  is  the  case,  all  active  cathartics  should  be  avoided. 

Continued  Fever. — Cathartics  are  no  less  important  than  in  the  pre- 
ceding forms  of  fever,  and  they  aet  by  restoring  intestinal  and  hepatic 
secretion,  moderating  general  excitement,  and  w7here  the  head  is  much 
affected,  exercising  a  salutary  revulsion  upon  the  bowels.  As  fevers  of 
this  kind  differ  materially,  the  kind  of  cathartics  and  the  degree  of  pur- 
gation must  be  determined  by  existing  circumstances.  "Where  the  liver 
is  particularly  implicated,  calomel  is  an  article  never  to  be  overlooked. 
Where  the  head  is  affected,  such  articles  as  are  calculated  to  produce  a 
decidedly  revulsive  effect  may  be  used,  such  for  example  as  jalap  and 
cream  of  tartar.  In  these  cases,  too,  more  free  purging  will  be  required 
and  prove  beneficial. 

In  the  use  of  cathartics,  the  period  ought  to  be  specially  considered. 
In  the  commencement,  purges  of  an  active  nature  may  be  required, 
while  as  it  advances,  and  especially  towards  the  latter  period,  such  milder 
articles  are  only  to  be  used  as  will  evacuate  the  bowels  without  pro- 
ducing irritation  on  the  one  hand  or  debility  on  the  other. 

From  the  foregoing,  it  must  appear  evident  that  Cathartics  are  agents 
of  great  value  in  fever  generally.  At  the  same  time,  it  is  to  be  recollected 
that  in  their  practical  application  great  abuses  have  arisen  and  much 
injury  is  constantly  done.  This  has  probably  arisen  from  attaching  to 
them  an  importance  somewhat  exaggerated.  They  are  accordingly,  by 
many,  relied  upon  almost  exclusively  in  the  cure  of  fever,  and  the  most 
active  purges  are  repeated  from  day  to  day  throughout  the  disease,  with 
the  most  unceasing  and  relentless  assiduity.  The  considerations  which 
have  already  been  offered,  must  convince  any  reflecting  person  that 
such  practice  is  irrational  and  attended  with  danger.  Besides,  it  should 
be  recollected,  that  fever  is  a  disease  affecting  the  whole  system — all  the 
functions  are  disordered  and  all  the  secretions  are  more  or  less  prevented. 
Now,  cathartics  are  only  one  of  the  means  of  cure,  and,  although  some 
mild  cases  of  fever  may  yield  to  them  alone,  yet  more  aggravated  forms 


106  MATERIA   MEDICA   AND   THERAPEUTICS. 

of  it  are  not  to  be  managed  by  exclusive  attention  to  the  bowels.  Im- 
portant as  this  is,  the  other  secretions,  especially  that  of  the  skin,  require 
equal  attention.  If  this  important  fact  was  constantly  borne  in  mind,  it 
would  tend  to  limit  the  use  of  cathartics  within  their  proper  bounds,  and 
obviate  much  of  the  evil  resulting  from-  their  use.  [In  the  abdominal 
typhus,  now  so  much  more  common  than  when  Dr.  Beck  practised, 
too  much  caution  cannot  be  used  in  prescribing  cathartics,  especially 
calomel.] 

The  great  objects  then  to  be  gained  by  the  use  of  cathartics,  in  fever, 
are : — 

1st,  To  relieve  congestion  of  the  abdominal  organs. 

2d,  To  restore  secretion — in  both  these  ways  they  prepare  the 
system  for  the  use  of  tonics. 

The  evils  they  may,  if  injudiciously  used,  produce,  are  : — 

1st,  They  may  produce  irritation  or  inflammation. 

2d,  They  may  produce  too  much  debility. 

Inflammation. — I  come  next  to  consider  the  use  of  cathartics  in  the 
various  forms  of  inflammation.  The  principles  upon  which  they  may 
be  rendered  available,  are  the  following  : 

1.  In  all  cases  of  inflammation,  the  functions  of  the  system  become 
more  or  less  disturbed,  and  among  these  none  more  so  than  those  of 
the  intestinal  canal.  Hence,  costiveness  is  a  frequent  attendant  in  these 
cases.  The  intestines  being  unnaturally  overloaded,  the  general  irrita- 
tion of  the  system  is  increased,  and  as  a  consequence  the  local  irritation 
is  aggravated. 

Again,  in  all  cases  of  inflammation,  in  consequence  of  the  general 
disturbance  of  the  system,  the  functions  of  the  mucous  lining  of  the 
intestines  are  deranged.  The  natural  action  of  the  secretory  vessels  of 
this  tissue  is  impaired,  the  general  excitement  is  increased,  and  the  local 
inflammation  aggravated. 

To  obviate  these  conditions,  cathartics  of  various  kinds  are  used,  and 
with  the  greatest  advantage.  By  keeping  the  bowels  continually  in  a 
free  state  they  remove  a  constant  source  of  irritation  ;  at  the  same 
time,  by  the  impression  which  they  make  on  the  mucous  membrane, 
they  restore  the  natural  secretions  of  the  part.  In  this  way,  general 
excitement  is  directly  lessened,  and  indirectly  the  local  inflammation 
moderated.  This  is  one  mode  in  which  cathartics  are  rendered  benefi- 
cial in  inflammation. 

2.  Cathartics,  some  more  and  some  less,  deplete  all  the  organs  and 
tissues  upon  which  they  operate,  and  in  this  way  by  the  evacuations 
which  they  produce,  lower  excitement  and  thus  prove  useful. 

3.  Another  mode  in  which  cathartics  prove  beneficial  in  many  cases 
of  inflammation,  is  by  the  new  action  which  they  create  in  the  intestinal 
canal,  operating  on  the  principle  of  revulsion. 


CATIIAUTHK.  J  07 

For  the  purpose  of  illustrating  the  foregoing,  let  us  notice  briefly 
Inflammation  as  it  assails  different  parts  of  the  body. 

(a.)  Inflammation  of  the  Brain. —  In  all  inflammations  affecting  this 
organ,  there  can  he  no  question  as  to  the  utility  of  cathartics.  Theor) 
sanctions,  experience  confirms  it.  In  all  cases  of  this  kind  there  is  a 
general  tendency  to  torpor  of  the  bowels.  In  consequence  of  this, 
accumulations  are  apt  to  occur  in  them,  and  by  their  distension  and 
pressure  on  the  surrounding  organs  and  large  blood-vessels,  they  crowd 
the  blood  unnaturally  towards  the  upper  part  of  the  body.  By  the 
judicious  use  of  cathartics  this  is  obviated.  But  they  operate  still 
further  and  more  decidedly.  They  create  a  determination  to  the 
abdominal  viscera,  and  they  relieve  the  brain,  upon  the  principle  of 
revulsion.  From  the  inactivity  of  the  bowels  generally  attending  these 
cases,  such  articles  will  be  required  as  act  efficiently  and  freely.  Among 
these,  calomel,  jalap,  senna,  salts,  and  in  some  cases,  croton  oil,  are 
most  to  be  relied  on.  To  produce  their  full  revulsive  effect,  it  is 
necessary  that  their  action  should  he  kept  up  for  a  considerable  length 
of  time.  For  this  purpose  they  should  be  repeated  from  day  to  dav 
according  to  circumstances. 

Trachitis. — In  this  disease  cathartics  may  be  used  with  advantage 
as  auxiliary  to  other  remedies.  In  the  selection  of  the  cathartic,  the 
preference  should  be  given  to  calomel.  Besides  operating  most  effi- 
ciently on  the  liver  and  intestinal  canal,  this  article  possesses  the 
additional  advantage  of  extending  its  sympathetic  action  to  the  inflamed 
membrane — promoting  the  secretions  of  the  part  and  lessening  general 
excitement.  To  obtain  the  best  effects  of  this  article  it  should  be  given 
in  full  doses,  and  repeated  at  suitable  intervals.  As  an  adjunct,  castor 
oil  is  the  best  article  that  can  be  used.  [Dr.  Beck's  fondness  for  calo- 
mel is  not  shared  by  the  physicians  of  the  present  day. — Ed.] 

Inflammation  of  the  Lungs. — The  propriety  of  having  recourse  to 
cathartics  in  this  form  of  disease,  has  been  made  a  question  by  some 
eminent  authorities.  Among  the  objections  urged  against  their  use, 
the  most  common  and  forcible  is  that  they  interfere  with  expectoration 
and  perspiration,  both  of  which  are  looked  upon,  and  justly,  as  exceed- 
ingly important  in  the  solution  of  thoracic  inflammations. 

To  a  certain  extent  this  objection  is  founded  in  truth.  That  active 
purging  does  have  a  tendency  to  check  expectoration  is  certainly  true* 
and  if  it  be  resorted  to  when  this  is  freely  going  on,  there  is  no  doubt 
it  may  prove  injurious.  It  is  to  be  recollected,  however,  that  expectora- 
tion only  commences  at  a  certain  period  of  the  inflammation,  and  the 
use  of  cathartics  antecedently  to  this  period  can  be  no  more  objection- 
able than  venesection  or  any  other  antiphlogistic  remedy.  With  reo-ard 
to  perspiration,  it  is  to  be  remarked,  that  in  inflammation  of  the  lungs, 
as  in  all  other  inflammations,  this  process  never  takes  place,  at  least  to 


108  MATERIA   MEDICA    AND   THERAPEUTICS. 

any  salutary  extent,  while  the  general  excitement  of  the  system  is 
above  a  certain  standard.  It  is  only  when  this  is  properly  subdued 
that  the  skin  becomes  free  and  perspirable.  Purging,  therefore,  in  the 
early  periods  of  the  disease,  by  lessening  excitement,  rather  favors  than 
otherwise  the  subsequent  process  of  perspiration.  In  the  early  stages 
of  thoracic  inflammation,  therefore,  purgatives  are  not  merely  innocent, 
but  may  be  made  exceedingly  valuable  auxiliaries ;  and  they  operate 
both  by  lessening  general  excitement  and  producing  a  revulsive  action 
upon  the  intestinal  canal.  When,  however,  the  inflammation  is  coming 
to  a  regular  crisis,  when  the  skin  is  soft  and  moist,  and  the  secretions 
from  the  mucous  membranes  of  the  lungs  free,  active  purging  should  be 
.avoided.  This  is  the  practical  distinction  to  be  observed  in  these 
cases.  The  eathartics  best  suited  here  are  calomel,  castor  oil,  and  the 
neutral  salts. 

Inflammation  of  the  Abdomen. — In  almost  every  case  of  this  kind, 
cathartics  may  be  used  with  advantage.  In  the  selection  of  cathartics, 
however,  and  in  the  extent  to  which  the  purgation  ought  to  be  carried, 
there  will  be  found  a  great  difference,  according  to  the  particular  tissue 
or  or<>'an  which  may  be  the  seat  of  inflammation.  This  will  be  best 
illustrated  by  noticing  in  detail  a  few  of  the  more  important. 

Inflammation  of  the  Mucous  Membrane  of  the  Stomach. — This  may 
exist  either  in  the  acute  or  in  the  chronic  form,  and  in  both  suitable 
evacuation  of  the  bowels  is  a  point  of  great  importance.  In  relation  to 
this  practice,  I  am  aware  that  a  great  difference  of  opinion  exists.  The 
propriety  of  it,  however,  appears  to  me  to  rest  upon  various  considera- 
tions. In  the  first  place,  should  the  faeces  be  suffered  to  accumulate  in 
the  large  intestines,  the  mere  pressure  upon  the  stomach  which  the 
distension  would  occasion  would  increase  the  gastric  irritation.  In  the 
•second  place,  accumulations  in  the  large  intestines  would  have  the  effect 
of  creating  irritation  in  the  mucous  membrane  of  these  organs,  which 
might  be  extended,  sympathetically,  to  the  mucous  membrane  of  the 
•stomach.  To  remove,  therefore,  all  cause  of  irritation  from  this,  source, 
it  is  essential  that  the  large  intestines  should  be  kept  freely  evacuated. 
In  the  mode  of  doing  this,  however,  certain  precautions  are  to  be 
attended  to.  As  a  general  rule,  it  is  not  to  be  accomplished  by  the 
introduction  of  cathartics  into  the  stomach.  In  the  irritable  condition 
of  the  stomach  in  these  cases,  ordinary  purgatives  will  be  very  apt  to  be 
rejected,  and  therefore  will  prove  useless.  In  addition  to  this,  if  they 
are  articles  of  an  active  character,  even  should  they  be  retained,  they  will 
be  apt  to  act  as  local  irritants,  and  thus  aggravate  the  inflammation. 
On  these  accounts,  active  enemata,  repeated  at  suitable  intervals,  are  to 
be  preferred  in  these  cases.  To  all  this,  however,  there  is  an  exception 
to  be  made  in  favor  of  one  cathartic — and  that  is  calomel.  This  article 
does  not  act  as  a  local  irritant.     Even  where  it  comes  in  contact  with 


CATHARTICS.  109 

inflamed  surfaces,  so  far  from  increasing  inflammation,  it  frequentl}  ha 
the  effect  of  allaying  it.  From  its  small  bulk,  also,  it  can  readily  be 
taken,  and  is  retained  on  the  stomach  when  every  other  article  is  rejected. 
Calomel,  therefore,  is  a  remedy  which  may  be  used  without  any  danger 
of  increasing  irritation;  and,  at  the  same  time,  by  its  antiphlogistic  ope- 
ration on  the  irritated  surface,  and  its  purgative  action  on  the  liver  and 
bowels,  may  prove  eminently  beneficial. 

Inflammation  of  the  Mucous  Membrane  of  the  Bowels. — Cathartics 
here  may  be  used  upon  the  same  principles  as  in  inflammation  of  the 
stomach.  To  keep  the  bowels  properly  evacuated  is  essential.  This, 
however,  is  to  be  accomplished  by  the  mildest  means.  All  active,  and 
especially  drastic,  cathartics  prove  injurious.  The  best  articles  to  be 
used  are  calomel  and  castor  oil. 

Inflammation  of  the  Serous  Membrane  of  the  Abdomen. — In  this  form 
of  inflammation,  considerable  difference  of  opinion  exists  with  regard  to 
the  use  of  cathartics.  By  some  the}7  are  considered  as  highly  injurious. 
This  opinion  does  not,  however,  appear  to  be  well  founded.  In  cases  of 
peritoneal  inflammation  the  bowels  are  generally  costive;  and  where 
this  is  the  case,  it  must  necessarily  add  to  the  existing  inflammation. 
By  the  use  of  cathartics,  this  is  obviated.  Besides,  where  the  mucous 
membrane  is  free  of  disease,  copious  secretion  may  be  produced  from 
this  surface  by  the  use  of  appropriate  cathartics,  and  in  this  way  may 
aid  very  powerfully  in  relieving  the  peritonseal  inflammation. 

Inflammation  of  the  Liver. — With  regard  to  the  use  of  cathartics  in 
this  form  of  inflammation,  there  is  in  American  and  British  practice 
very  little  difference  of  opinion.  By  the  French,  and  especially  the 
followers  of  Broussais,  they  are  reprobated.  Their  objections  go  upon 
the  supposition  that  purgatives  are  all  irritating  in  their  nature.  That 
some  purgatives  are  so  is  unquestionably  true,  and  these  ought  certainly 
to  be  avoided.  Every  active  cathartic,  however,  is  not  of  this  character. 
Calomel  and  castor  oil  are  not  so,  and  these  may  be  used  with  perfect 
impunity  so  far  as  any  irritation  which  they  occasion  is  concerned — and 
so  far  from  being  injurious,  their  use  is  sanctioned  both  by  theory  and 
experience.  After  the  free  use  of  the  lancet,  there  is  no  remedy  so  salu- 
tary as  a  large  dose  of  calomel,  followed  by  castor  oil  and  some  of  the 
saline  cathartics.  Should  these  act  freely  on  the  bowels,  they  relieve 
the  oppression  and  fulness  about  the  region  of  the  liver,  and  at  the  same 
time  aid  in  subduing  inflammation;  and  they  operate  by  the  free  secre- 
tion which  they  produce  from  the  liver  and  the  mucous  membrane  of 
the  intestines,  acting  both  as  evacuants  and  revulsives.  When  tardy  in 
their  operation,  they  should  be  aided  by  enemata. 

Inflammation  of  the  Kidneys  and  Bladder. — In  both  mild  cathartics 
may  be  used  with  advantage.  They  relieve  the  inflamed  organs  from 
the  pressure  resulting  from  an  overloaded  state  of  the  bowels,  and  at  the 


HO  MATERIA   MEDIC  A   AND    THERAPEUTICS.' 

same  time  act  beneficially  as  evacuants.  From  the  sympathies  existing 
between  the  kidneys  and  bladder  and  the  rectum,  all  such  cathartics  as 
are  apt  to  produce  irritation  in  the  latter  organ  should  be  avoided. 
Some  cathartics,  too,  have  a  tendency  to  pass  off  by  the  urinary  organs, 
and  when  this  is  the  case  they  add  to  the  existing  inflammation.  Upon 
this  principle,,  the  saline  cathartics  are  objectionable. 

Rheumatism.-^— -In  the  acute  form  of  this  disease,  cathartics  are  of 
great  value.  They  prove  beneficial,  as  evacuants,  by  diminishing  general 
excitement,  and  as  revulsives,  in  keeping  up  a  determination  to  the 
bowels.-  The  best  articles  to  be  used  are  an  occasional  dose  of  calomel, 
followed  by  the  saline  cathartics.  [Most  of  us  now  give  the  salines 
without  calomel.] 

Gout. — Here,  cathartics  are  no  less  needful.  Everything  connected 
with  this  disease  shows  how  intimately  it  is  associated  with  disorders  of 
the  digestive  organs.  From  the  slow  and  continued  operation  of  vari- 
ous causes,  the  secretions  of  the  liver  and  bowels  become  vitiated — 
there  is  costiveness  and  acidity — the  bowels  become  loaded  with  mucus, 
and  a  general  debility  of  the  whole  abdominal  system  ensues.  In  this 
condition  of  things,  free  evacuation  of  the  alimentary  canal,  and  a  con- 
stant action  on  it,  cannot  fail  to  do  good. 

Dropsies. — There  is  perhaps  no  class  of  diseases  in  which  the  use  of 
cathartics  has  been  so  generally  concurred  in  as  in  dropsies,  and  there 
can  be  no  question  with  regard  to  their  general  utility.  They  are  not, 
however,  to  be  given  indiscriminately.  For  the  purpose  of  understand- 
ing the  principles  upon  which  they  are  to  be  used,  and  the  extent  to 
which  they  may  be  carried,  it  is  necessary  to  have  correct  notions  of 
the  disease  for  which  they  are  prescribed.  By  dropsy,  in  the  ordinary 
acceptation  of  the  term,  is  meant  nothing  more  than  the  accumulation 
of  fluids  in  different  parts  of  the  body.  This,  however,  conveys  a  very 
imperfect  idea  of  the  real  nature  of  the  affection.  This  accumulation  of 
fluids  is  a  mere  effect  or  consequence  of  some  deranged  condition  of  the 
system  at  large,  and  more  especially  of  the  capillaries,  the  vessels  con- 
cerned in  excreting  and  absorbing  the  fluids.  [Distension  of  the  blood- 
vessels, either  of  the  whole  or  part  of  the  body,  is  the  essential  condi- 
tion of  the  occurrence  of  dropsy.  It  is  probable  that  the  distended 
arteries,  or  the  arterial  capillaries,  sometimes  relieve  themselves  by 
pouring  out  the  serum  of  the  blood,  but  it  is  from  the  veins  and  venous 
capillaries  that  this  exhalation  takes  place  to  the  greatest  extent;  while 
at  the  same  time,  their  distended  state  entirely  prevents  the  taking  up 
of  effused  fluids,  a  function,  in  the  normal  state  of  the  system,  performed 
by  the  veins.  Now,  this  essential  condition  of  dropsy,  distension,  may 
be  the  rapidly  induced  effect  of  some  suddenly  applied  cause,  or  it  may 
result  gradually  from  some  chronic  condition.  In  the  first  case,  the 
consequent  dropsy  will  be  active  or  acute ;  in  the  latter,  passive.     Scar- 


CATIIAKTK  S.  Ill 

latina  dropsy,  and  the  dropsy  which  suddenly  follows  exposure  to  cold 
in.  persons  previously  in  good  health,  are  familiar  examples  of  active 
dropsy;  while  the  anasarca  of  pregnant  women  and  cardiac,  dropsy  be- 
long to  the  passive  variety.  From  this  view  of  dropsy,  it.  is  obvious 
that  our  attention  should  be  very  mainly  directed  to  the  removal  of  the 
distended  state  of  the  vessels;  and  as,  in  very  many  cases,  the  direct 
diminution  of  the  quantity  of  circulating  blood  is  forbidden  by  the  debi- 
litated condition  of  the  general  system,  we  must  resort  to  purgatives, 
diuretics,  and  diaphoretics,  in  order  to  eliminate  from  the  vessels  their 
more  watery  parts,  being  well  assured  that  the  partially  emptied  v< 
will  seize  on  watery  fluid  wherever  they  can  find  it.  Cathartics  are  the 
most  important  of  these  evacuants,  as  more  certain  than  diuretics,  and 
more  efficient  than  diaphoretics.] 


CLASSIFICATION  OF  CATHARTICS, 

Cathartics  may  be  advantageously  classified,  according  to  their  effects, 
into  three  divisions. 

1.  Those  which  operate  principally  by  increasing  the  natural  peristaltic 
action  of  the  intestines,  causing  little  or  no  increase  of  secretion  from 
the  mucous  lining  of  these  organs.  As  a  general  rule,  they  act  with 
great  mildness,  and  their  operation  is  limited  in  a  great  measure  to 
evacuating  the  existing  contents  of  the  bowels.  To  this  division  belong 
the  whole  class  of  what  are  usually  called  Laxatives.  Under  this  head 
may  be  ranged  castor  oil,  magnesia,  sulphur,  manna,  'purging  cassia, 
tamaHnds,  rhubarb  and  aloes,  charcoal. 

2.  Those  which,  in  addition  to  increasing  the  natural  peristaltic 
motion,  stimulate  the  exhalant  vessels  of  the  intestines,  and  thus  cause 
free  secretion  from  them.  Besides  unloading  the  bowels,  these  produce 
watery  evacuations.  In  the  degree  of  activity  in  the  articles  of  this 
class  there  is  a  good  deal  of  difference,  some  operating  very  mildly,  while 
others  produce  considerable  irritation.  To  this  division  belong  the 
whole  class  of  hydragogue  cathartics  ;  neutral  salts,  jalap,  Mag  cqjjjle, 
senna,  scammony,  gamboge,  siipertartrate  of  potass,  colocynth,  elaterium, 
croton  oil. 

3.  Those  which,  in  addition  to  increasing  the  natural  peristaltic 
motion,  excite  the  mucous  follicles  of  the  intestinal  canal,  and  at  the 
same  time  extend  their  influence  to  the  liver.  The  evacuations  pro- 
duced by  this  class  are  mucous  and  bilious.  To  this  belong  calomel  and 
blue  pill.  Other  cathartics  act  also  on  the  liver,  especially  the  drastic 
ones,  but  not  in  the  way  calomel  does;  calomel  produces  its  effect 
mildly — the  others  by  irritation. 


112  MATERIA   SIEDICA    A  JO)    THERAPEUTICS. 


INDIVIDUAL  CATHARTICS. 

CASTOR    GIL. 

The  plant  which  yields  this  valuable  article  is  the  Ricinus  communis, 
so  called  from  the  seeds  resembling  in  shape  and  color  the  insect  called 
the  tick  (ricinys).  It  grows  in  great  abnndance  in  the  East  Indies, 
where  it  is  native.  It  is  also  a  native  of  Africa.  In  the  "West  Indies, 
in  various  parts  of  Europe,  but  more  especially  in  the  southern  part  of 
the  United  States,  it  is  extensively  cultivated.  It  is  an  annual  plant  of 
very  speedy  growth,  from  four  to  six  feet  high.  In  the  warmer  climates 
it  sometimes  attains  the  height  of  eight,  ten,  twenty,  and  even  thirty 
feet. —  (Ray,  Roxburg.)  The  oil  used  in  medicine  is  obtained  from  the 
seeds.  These  are  inclosed  in  rough  capsules,  which  are  about  the_  size 
of  a  large  marble,  of  a  pale  green  color,  and  covered  with  flexible  prickles. 
Each  of  the  capsules  contains  three_  seeds,  which  are  expelled  by  the 
bursting  of  the  capsules.  The  seeds  are  of  an  oval  shape  and  of  the  size 
of  a  small  bean,  a  quarter  to  one  third  of  an  inch  long,  of  a  pale. greyish 
color,  marbled  with  yellowish  brown  spots  and  veins.  When  the  external 
coat  is  taken  off,  it  leaves  a  kernel  of  a  white  color,  which  has  a  sweet- 
ish, oily,  and  somewhat  nauseous  taste.  In  their  action  on  the  system, 
the  seeds  are  acrid  and  irritating;  three  or  four  of  them  prove  actively 
emetic  and  cathartic. 

Modes  of  preparing  the  oil. — These  are  different  in  different  countries. 
In  the  United  States,  -where  the  oil  is  manufactured  very  extensively, 
the  process  is  the  following  : — The  seeds,  after  being  well  cleansed,  are 
put  into  a  shallow  iron  receiver,  where  they  are  subjected  to  a  very 
gentle  heat,  for  the  purpose  of  rendering  the  oil  sufficiently  liquid  for 
easy  expression.  They  are  then  put  into  a  powerful  screw  press,  by 
which  a  whitish  oily  liquid  is  obtained.  This  is  then  put  into  clean 
iron  boilers,  mixed  with  water,  and  boiled.  During  the  boiling,  the 
impurities  which  rise  to  the  surface  are  skimmed  off,  until,  at  last,  a  pure 
oil  is  left  on  the  surface  of  the  water.  The  clear  oil  is  now  carefully 
separated,  "  and  the  process  is  completed  by  boiling  it  with  a  minute 
proportion  of  water,  and  continuing  the  application  of  heat,  till  aqueous 
vapor  ceases  to  rise,  and  till  a  small  portion  of  the  liquid,  taken  out 
in  a  vial,  preserves  a  perfect  transparency  when  it  cools.  The  effect  of 
this  last  operation  is  to  clarify  the  oil,  and  to  render  it  less  irritating  by 
driving  off  the  acrid  volatile  matter.'T  If  the  heat  employed  be  too 
great,  the  oil  becomes  of  a  brownish  color  and  of  an  acrid  taste.  Great 
care,  therefore,  is  necessary  in  regulating  the  degree  of  heat.  Good 
seeds,  by  this  process,  yield  twenty-five  per  cent,  of  oil. 

By  Alcohol.      This  is  another  mode  recently  suggested  in  France, 


CATHARTICS.  1  I  3 

and  is  founded  on  the  solubility  of  castor  oil  in  alcohol.  It.  consists  in 
macerating  the  kernels,  made  into  u  paste,  in  cold  alcohol.  In  this 
way  3  vi  of  oil  are  extracted  from  a  pound  of  the  seeds. 

The  mode  of  preparing  castor  oil  is  a  matter  of  much  practical 
importance,  inasmuch  as  it  modifies  its  qualities  and  effects*.  It  has 
already  been  stated  that  the  seeds  are  exceedingly  iiritating,  and  the 
same  is  sometimes  the  case  with  the  oil.  What  the  cause  of  this  may 
be,  is  a  point  which  has  given  rise  to  a  difference  of  opinion.  By  some 
it  is  supposed  to  be  owing  to  an  acrid  principle  residing  in  the  seeds, 
while  by  others  it  has  been  attributed  to  the  employment  of  heat  in 
the  preparation. 

With  regard  to  the  acrid  principle,  some  suppose  it  to  reside  in  the 
•shells,  while  others  locate  it  in  the  embryo.  According  to  Guibourt, 
however,  the  shells  contain  none  of  it;  and  the  only  effect  which  they 
can  have  is  to  color  the  oil.  Nor  does  it  reside  exclusively  in  the 
embryo.  The  truth  is,  the  whole  kernel  appears  to  contain  a  volatile 
acrid  principle.  By  boiling  in  water  this  principle  is  carried  off,  and  a 
bland  and  almost  colorless  oil  is  obtained. 

With  regard  to  the  agency  of  heat,  it  appears  that  too  great  a  degree 
of  heat,  or  too  long  continued,  changes  the  nature  of  the  oily  principle 
itself;  in  consequence  of  which  it  becomes  deeper  colored  and  acrid. 

From  the  foregoing  it  would  seem  :  1.  That  the  removal  of  the  shells 
is  not  necessary.  2.  That  the  great  point  is  the  proper  graduation  of 
the  heat. 

Properties. — Castor  oil  is  a  thick,  viscid  fluid ;  little  or  no  smell ;  a 
mild  and  somewhat  nauseous  taste,  leaving  behind  it  a  slight  sensation 
oflicrimony  in  the  throat.  When  pure,  it  is  colorless.  Generally, 
however,  of  a  light  straw  color. 

When  prepared  by  decoction,  or  when  the  degree  of  heat  has  been 
too  great,  it  is  of  a  brownish  color,  and  has  a  hot  and  acrid  taste. 
When  exposed  to  the  air,  it  becomes  thick  and  rancid,  without  becom- 
ing opaque. 

Composition. — When  distilled,  castor  oil  yields,  besides  a  little  gas, 
water,  and  acetic  acid — 

A  colorless,  odorous,  volatile  oil.  Two  fatty  acids — the  Rieinic  and 
Oleo-Ricinic,  or  Elaiodic ;  both  excessively  acrid.  A  residual  solid 
matter  of  a  peculiar  character.  The  volatile  oil  and  the  acids  make  up 
about  one  third,  while  the  residual  matter  makes  up  the  remaining 
two  thirds. 

Castor  oil  possesses  the  general  properties  of  the  fixed  oils,  except 
that  it  is  wholly  soluble  in  alcohol  and  ether.  Diluted  alcohol  dissolves 
about  two  thirds. 

Purity. — Sometimes  adulterated  with  more  common  oils.  This  is 
tested  by  its  solubility  in  alcohol.     If  castor  oil  be  genuine,  by  adding 


114  MATERIA    MEDICA    ASTD   THERAPEUTICS. 

to  it  an  equal  quantity  of  alcohol  of  sp.  gr.  '820,  a  uniform  solution 
will  be  made.  On  the  contrary,  if  it  form  a  milky  mixture  or  any 
portion  remain  undissolved,  an  adulteration  with  some  of  the  more 
common  fixed  oils  may  be  suspected. 

Effects. ->- As  a  cathartic  it  possesses  many  valuable  properties.  It 
operates  gently,  yet  efficaciously.  While  it  thoroughly  evacuates  the 
intestines,  it  causes_no_griping  ov  pain.  The  number  of  evacuations 
caused  by  a  single  dose  seldom  exceeds  two  or  three.  Besides  operat- 
ing mildly,  it  produces  its  effects  with  more  rapidity,  than  jmost  other 
cathartics.  It  frequently  acts  in  a  couple  of  hours,  and  seldom  takes 
longer  than  three  or  four.  A  peculiarity  attending  its  operation  was 
remarked  by  Dr.  Cullen,  viz.  if  it  be  frequently  repeated,  the  same 
effect  will  be  produced  by  diminished  doses.  Generally  speaking,  the 
oil  may  be  recognised  in  the  evacuations,  sometimes  appearing  in 
masses,  and  in  one  case  mentioned  by  Pereira  in  the  form  of  nodules, 
like  biliary  concretions. 

From  the  peculiar  operation  of  this  article  it  is  an  exceedingly  valua- 
ble cathartic,  and  well  calculated  to  fulfil  many  indications  which  no 
other  can  accomplish.  It  is  adapted  to  all  cases,  when  the  object  is  to 
evacuate  the  bowels  freely,  without  causing  any  irritation,  and  without 
producing  alvine  secretion.  It  is  admirably  well  adapted  to  follow  the. 
use  of  mercurial  cathartics,  of  which  it  insures  the  operation  without 
altering  the  effects.  For  this  purpose  it  is  superior  to  any  other  cathar- 
tic.    For  children  it  is  a  peculiarly  safe  and  good  laxative. 

In  some  cases,  an  objection  to  its  use  is  that  it  leaves  the  bowels 
costive.     In  other  cases  this  is  an  advantage. 

Mode  of  administration  and  dose. — For  adult,  |j  ;  child  3j  to  3  ij. 
Simply  thinned  by  heat,  the  best  form  of  giving  it,  or  mixed  with 
syrup,  sugar,  hot  coffee,  or  milk,  or  in  emulsion  with  yolk  of  egg  and 
sugar,  or  floating  on  spirit. 

MAGNESIA. 

Magnesia  is  used  in  medicine  in  three  different  forms — magnesia,  car- 
bonate of  magnesia,  and  sulphate  of  magnesia.  At  present  the  two  first 
are  only  to  be  considered. 

Magnesia. — From  the  manner  in  which  it  is  prepared,  commonly 
called  magnesia  usta  or  calcinata. 

It  is  prepared  by  subjecting  the  carbonate  of  magnesia  in  a  crucible 
to  a  red  heat  for  about  two  hours,  or  until  no  effervescence  is  produced 
on  the  addition  of  diluted  acetic  acid.  During  this  process,  the  water 
and  carbonic  acid  are  driven  off  and  the  pure  magnesia  left.  When 
cool,  it  is  to  be  put  into  tightly  stopped  bottles. 


CATHARTICS.  11.", 

Composition, —  One  eq,  magnesium  =  12,  one  eq.  oxygen  8      20. 

Properties. — A  white  powder,  without  snoel],  and,  if  perfectly  pure, 
without  taste.  It  is  very  light,  its  specific  gravity  being  '!'■>.  It .  i 
sparingly  soluble  in  water — more  so  in  cold  than  in  hot.  According  to 
Dr.  Fyfe,  it  requires  5,142  parts  of  cold  water  and  36,000  parts  of  hot 
to  dissolve  it.  With  acids  it  docs  not  effervesce.  Uy  exposure  to  the 
atmosphere,  it  slowly  attracts  carbonic  acid  and  is  converted  into  the 
carbonate.     Hence  the  necessity  of  keeping  it  in  tight  bottles. 

Parity. — The  most, common  adulteration  is  the  admixture  of  car- 
bonate of  magnesia.  This  is  ascertained  by  adding  to  it  a  little  diluted 
hydrochloric  acid.  The  best  way  is  to  mix  a  little  of  the  magnesia 
in  water  and  then  add  a  few  drops  of  acid.  If  pure,  it  should  not 
effervesce. 

Sometimes  it  contains  lime,  either  added  fraudulently,  or  obtained 
from  the  carbonate,  from  which  it  has  been  prepared.  This  may  be 
ascertained  by  dissolving  the  magnesia  in  hydrochloric  acid,  neutralize 
the  acid  solution  with  ammonia,  dilute  it  with  water,  and  add  to  it  a 
solution  of  oxalate  of  ammonia.  If  there  is  a  wdiite  precipitate,  it  shows 
the. presence  of  lime. 

Carbonate  of  Magnesia,  commonly  known  by  the  name  of  magne- 
sia alba  and  sub-carbonate  of  magnesia.  In  Hindostan  and  some  parts 
of  this  country  it  is  found  native.  What  is  used  in  medicine  is  prepared 
artificially. 

The  mode  of  preparing  it  is  to  add  together  solutions  of  sulphate  of 
magnesia  and  carbonate  of  potash  or  soda — boil  the  mixture  "tor  a  short 
time,  stirring  it  the  while.  On  standing,  the  carbonate  of  magnesia 
is  precipitated,  while  the  sulphate  of  potash  or  soda  is  held  in  solution. 
The  liquor  is  then  to  be  poured  off,  and  the  precipitated  powder  well 
washed  with  boiling  distilled  water  and  dried.  The  washing  separates 
whatever  of  the  sulphate  of  potash  or  soda  may  remain  in  combination 
with  it.  Sometimes  it  is  dried  in  wooden  moulds,  in  consequence  of 
which  it  has  the  square  form  in  which  it  is  found  in  the  market. 

Another  mode  of  preparing  it  is  from  the  bittern,  or  liquor  which 
remains  after  the  crystallization  of  salt  from  sea  water.  The  bittern 
consists  chiefly  of  muriate  and  sulphate  of  magnesia.  This  is  heated  to 
212°  and  a  solution  of  carbonate  of  potash  is  added.  The  same  process 
is  then  gone  through  as  before. 

In  the  United  States  this  article  is  extensively  manufactured,  particu- 
larly at  Boston  and  Baltimore. 

Composition. — According  to  Berzelius,  100  parts  consist  of  magnesia, 
44-75  ;  carbonic  acid,  So'11 ;  water,  19*48. 

Properties. — Carbonate  of  magnesia,  as  found  in  the  shops,  is  either 
in  powder  or  square,  masses.  It  is  perfectly  white,  tasteless,  and  without 
smell ;  very  light  (48  grs.  fill  an  ounce  measure,  Pereira).     It  i?  nearly 


116 


MATERIA    MEDICA   AND   THERAPEUTICS. 


insoluble  in  water,  requiring ,2,473  parts  of  cold,  and  9,000  parts  of 
boiling-  water  to  dissolve  it.  In  carbonic  acid  water,  readily  soluble — 
unaffected  by  exposure  to  tbe  atmosphere — effervesces  witfr  acidTand  is 
decomposed  by  a  strong  heat. 

Impurities  and  Adulterations. — Magnesia  frequently  contains  car- 
bonate of  lime  (chalk),  sometimes  added  fraudulently,  sometimes  arising 
from  the  presence  of  calcareous  salts  in  the  compounds  employed  in  the 
preparation  of  magnesia. 

Effects. — Magnesia,  either  in  the  state  of  calcination  or  of  the  car- 
bonate, is  a  gentle  laxative.  From  its  great  affinity  for  acids,  it  readily 
unites  with  these  in  the  intestinal  canal,  and  when  it  meets  with 
enough  of  those  existing  there,  it  forms  soluble  salts,  and  thus  its 
activity  is  increased.  From  the  fact  of  its  thus  uniting  with  and 
neutralizing  acids,  it  acts  powerfully  in  allaying  gastric  and  intestinal 
irritation. 

As  a  cathartic,  this  article  is  peculiar,  and  it  is  indicated  where  jicidity 
and  disordered  secretion  of  the  stomach  and  bowels  are  present.  For 
children  it  is  an  invaluable  agent.  It  corrects  acidity,  allaysjrritation, 
and  operates  with  sufficient  activity  as  a  cathartic.  It  does  not  gene- 
rally produce  any  serous  evacuations,  unless  the  quantity  of  acid  with 
which  it  meets  is  very  great.  [In  such  cases  it  often  operates  very  vio- 
lently, causing  pain  and  profuse  serous  discharges ;  this  is  a  very  great 
objection  to  magnesia.  The  article  is,  I  believe,  very  much  abused ;  as 
a  habitual  or  domestic  remedy,  its  use  ought  to  be  proscribed.]  It  gene- 
rally renders  the  evacuations  of  a  lighter  color.  Calcined  magnesia  is 
preferable  to  the  carbonate,  because  in  the  latter  so  much  carbonic  acid 
gas  is  extricated  as  frequently  to  cause  painful  distension  of  the  intes- 
tines. Magnesia,  when  used  for  a  long  while,  sometimes  accumulates  in 
the  bowels  in  solid,  hard  masses,  concreted  by  intestinal  mucus,  and  they 
may  cause  mischievous  irritation.  A  mass  of  this  sort,  weighing  from 
four  to  six  pounds,  was  found  in  the  colon."* 

Dose. — Of  the  carbonate  for  an  adult,  from  3i  to  3  ij  ;  a  child  from 
2  to  10  grs.  Calcined  magnesia  somewhat  less.  It  may  be  given  in 
milk  or  water  intimately  mixed.  If  a  glass  of  lemonade  be  taken  imme- 
diately after  the  magnesia  is  swallowed,  its  efficacy  as  a  cathartic  is 
increased.  Of  course  its  power  as  an  antacid  is  diminished.  Where 
flatulence  is  dreaded,  give  the  alkali  in  mint  or  anise  water. 


This  substance  is  extensively  diffused  throughout  the  mineral,  the 
vegetable,  and  the  animal  kingdom.     It  is  found  native  and  in  combi- 

*  Pereira  sub  Yoce. 


CATHARTICS. 


lien 


nation  either  in  the  sulphurets  or  in  the  state  of  sulphuric  acid.     W 
native  it  is  found  either  in  musses  or  crystallized.     Native  sulphur  is 
found   most  abundantly  in  volcanic  countries,  and  the  great  mass  oi 

what  we  use  in  the  arts  and  in  medicine  comes  from  the  south  of  Italy, 
where  it  abounds.     The  sulphur  of  commerce  is  procured  chiefly  by 

distillation  from  the  native  sulphur,  though  in  some  parts  of  Europe  it 
is  obtained  from  the  sulphuret  by  strong  heat.     Sulphur  is  found  |n  the 

shops  in  two  states.  In  rolls,  the  roll  of  brimstone  of  commerce,  and  in 
fine  powder,  the  flowers  of  sulphur.  Of  each  of  these  there  are,  or  at 
least  were,  two  varieties';  forroll  brimstone  was  formerlj  prepared  by 
simply  melting  the  crude  sulphur,  when  the  impurity  being  allowed  to 
subside,  the  pure  sulphur  was  poured  off  and  received  into  moulds. 
Now,  however,  the  roll  sulphur  is  usually  prepared  by  distillation,  the 
product  being  afterwards  melted  and  run  into  moulds.  If  the  product 
of  distillation  be  received  into  a  large  sulphur  chamber,  it  is  deposited 
upon  the  walls  in  the  form  of  fine  powder.  This  is  the  common  flowers 
of  sulphur.  And  if  this  be  afterwards  carefully  washed  till  the  water 
no  longer  stains  litmus,  it  is  the  sulphur  lotum — the  washed  sulphur  oi 
the  shops. 

Properties. — An  elementary  body  of  a  pale  yellow  color,  permanent 
in  the  air.  When  in  rolls  or  masses  it  is  crystalline  or  amorphous.  It 
has  little  smell  unless  rubbed,  and  no  taste ;  is  a  bad  conductor  of  elec- 
tricity;  it  is  perfectly  volatilizable — fuses  at  400°. 

Effects. — In  closes  of  from  one  to  three  drachms  sulphur  acts  as  a 
mild  evacuant  of  the  alimentary  canal,  causingjittle  irritation,  and  hav- 
ing scarce  any  effect  on  the  secretions.  It  is  a  good  remedy  where  a 
purgative  is  wanted,  and  yet  some  diseases  of  the  rectum,  as  stricture, 
prolapsus  ani,  or  hemorrhoids,  render  the  irritating  effect  of  ordinary 
purgatives  objectionable.  To  render  it  more  prompt  and  certain  it  is 
often  combined  with  cream  of  tartar,  and  less  frequently  with  magnesia. 
[It  is  much  to  be  regretted  that  sulphur  is  so  little  used  as  a  laxative ; 
we  have  few  that  are  as  good,  especially  for  children.] 

Dose  as  a  purgative,   3  i  to  3  iij... 


MANNA. 

[A  concrete  juice  obtained  from  several  specimens  of  the  genus  Fraxi- 
nus,  and  also  of  genus  Omits  (a  genus  detached  from  Fraxinus  by  Per- 
soon).  A  substance  resembling  manna  is  obtained  from  trees  of  two  or 
three  species,  as  Hedysarum  and  Eucalyptus^ 

Manna  is  obtained  by  making  slight  incisions  in  the  bark,  though 
some  of  it  flows  spontaneously.  The  juice  appears  first  as  a  clear  viscid 
fluid,  but  soon  concretes  in  the  shape  of  ridges  or  stalactites.     The 


118  MATERIA    MEDICA    AND   THERAPEUTICS. 

manna  harvest  begins  in  July  and  continues  till  October.  There  are 
many  varieties,  which  seem  to  depend  on  the  season  and  mode  of  col- 
lection. Of  these  the  flake  manna  is  the  best.  It  comes  in  pieces  from 
one  to  six  inches  long,  brittle,  dry,  white  or  yellowish  white,  hoi  lowed 
in  the  side  to  which  it  has  adhered  to  the  tree.  It  has  a  faint  odor,  and 
a  sweet,  though  somewhat  sharp,  peculiar  taste. 

Manna  in  sorts. — This  is  a  common  kind,  and  seems  to  be  ajmixture 
of  the  flake  with  fatty  manna.  It  is  in  smaller  pieces,  palejbrown,  not 
flaky  or  crystalline. 

Fatty  Manna. — This  is  rarely  met  with.  It  is  of  a  reddish  brown, 
soft,  viscid,  having  a  strong  honey  smell,  and  a  mawkish-taste.  It  con- 
tains many  impurities. 

Composition. — The  principal  ingredients  in  manna  are  a  peculiar 
sweetish  principle  called  ^mannite,  60;  sugar  and  a  bitter  purgative 
matter,  5*5  ;  and  water,  32.  Manna  softens  by  the  heat  of  the  hand, 
and  melts  at  125°.  It  dissolves  in  three  parts  of  water  and  in  eight  of 
alcohol. 

Effects. — Manna  is  nutritive  and  laxative.  It  operates  mildly,  but  is 
apt  to  produce  flatulence  and  griping.  From  its  mildness  it  was  for- 
merly often  given  to  women,  especially  when  in  the  state  of  pregnancy. 
For  the  same  reason,  and  for  its  sweetish  taste,  it  was  given  to  children. 
But  it  is  now  very  rarely  used  alone,  and  not  by  any  means  as  fre-  " 
quently  in  combination  with  senna,  with  which  it  was  once  the  fashion 
in  medicine  to  unite  it. 

Dose. — One  ounce  for  an  adult,  three  drachms  for  a  child. 

cassia  fistula  [purging  cassia). 

The  cassia  fistula  grows  in  the  East  Indies,  Egypt,  Arabia,  and  Per- 
sia, also  in  the  West  Indies  and  South  America.  It  is  a  fine  tree,  thirty 
or  forty  feet  high.  The  fruit  is  a  cylindrical  pod  about  an  inch  in  dia- 
meter, and  from  one  to  two  feet  long.  The  outside  is  hard  and  dark 
brown ;  the  inside  divided  into  numerous  cells,  each  of  which  contains 
one  smooth,  oval,  shining  seed,  imbedded  in  a  soft  pulp.  This  pulp  is 
the  part  used  in  medicine. 

Effects. — To  produce  any  effect,  it  must  be  taken  pretty  freely,  as  a 
small  quantity,  being  digested,  fails  altogether  of  any  cathartic  effect. 
An  ounce  will  act  as  a  mild  laxative.  Its  coloring  matter  often  blackens 
the  stools.     It  is  very  little  used. 

tamarindi  fructus  [tamarinds). 

This  is  the  fruit  of  a  large  and  very  beautiful  tree  growing  in  India, 
Arabia,  and  Egypt,  and  also  in  the  West  Indies.     The  fruit  is  a  pod  the 


CATHARTICS*  I  I  0 

size  of  that  of  the  garden  bean.  It  lias  a  brittle  woody  dusk,  containing 
one  or  more  seeds  imbedded  in  a  pulp.  It  is  imported  free  from  bu  !  , 
and  is  preserved  in  raw  sugar. 

Effects.— K  very  gentle  cooling  laxative,  usually  employed  to  make  a 
pleasant  drink  in  fever.     It  is  very  rarely  used  alone  as  a  laxative. 

Tamarind  whey,  made  by  boiling  an  ounce  of  tamarinds  in  a  pjnl  of 
milk  and  straining,  is  a  pleasant  cooling  drink,  also  slightly  laxative. 


This  is  the  product  of  different  species  of  Rheum,  of  which  there  are 
a  number.  This  plant  grows  in  Tartary  and  China,  and  is  cultivated  in 
different  parts  of  Europe.  Which  of  the  species  yield  the  rhubarb  of 
commerce,  is  not  precisely  known.  The  species  cultivated  in  England 
is  the  R.  palmatum.  In  France,  the  R.  undulatum,  compactum,  and 
Rhaponticum, 

The  mode  of  preparing  it  in  the  East  is  the  following:  The  root  is 
dug  up  in  the  spring  and  autumn,  and  after  removing  the  bark  it  is  cut 
into  pieces,  through  which  holes  are  bored  for  the  purpose  of  passing 
cords.  By  these  they  are  hung  up  and  dried.  During  this  process  the 
root  loses  much  of  its  weight. 

General  properties.~*-Rhuharb  comes  in  solid  pieces  of  considerable 
size,  covered  with  dust  of  a  yellow  color.  When  this  is  rubbed  off,  the 
surface  presents  a  reddish  white  tint,  of  a  reticular  appearance.  When 
broken,  the  fracture  is  rough,  presenting  a  variegated  appearance,  owing 
to  the  intermingling  of  white,  red,  and  yellow  parts.  Here  and  there 
are  found  a  stardikc  spot,  and  numerous  streaks  and  veins  of  a  red 
color;  its  odor  is  peculiar  and  aromatic — taste  bitter  and  astringent. 
When  chewed,  stains  the  saliva  yellow  and  feels  gritty,  owing  to  the 
oxalate  of  lime  ;  yields  a  powder  of  a  yellow  color. 

The  principal  varieties  of  this  article  found  in  the  market,  are  the 
Turkey,  Chinese,  and  European, 

Turkey. — This  is  the  same  as  the  Russian  rhubarb,  and  is  the  best 
kind.  This  rhubarb  comes  from  Tartary,  and  is  brought  to  a  place 
called  Kieatcha,  a  Russian  town  on  the  frontiers  of  China.  Here  the 
article  is  examined  by  an  agent  of  the  Russian  government,  and  the  bad 
pieces  rejected.  Thence  it  is  sent  to  St.  Petersburgh,  from  -whence 
it  is  exported  to  different  parts  of  Europe.  Formerly  it  was  sent  from 
Tartary  to  Turkey  through  Natolia.  Hence  the  name  of  Turkey 
rhubarb,  which  it  more  commonly  bears  even  at  present. 

.  Chinese. — Also  called  East  India,  rhubarb.  This  comes  from  Canton, 
and  is  supposed  to  be  obtained  from  a  species  of  rheum,  growing  in 
China.    Although  resembling  each  other  in  their  general  properties,  the 


120  MATERIA    MEDIC  A    AND   THERAPEUTICS. 

Russian  and  Chinese  R.  may  be  readily  distinguished.  This  is  import- 
ant, as  the  first  is  much  dearer  than  the  second,  and  frauds  are  frequently 
practised  in  the  sale.     They_ differ — 

1.  In  the  shape  of  the  pieces..  The  Russian  has  a  somewhat  angular 
appearance,"  as  if  the  bark  had  been  shaved  off,  taking  pieces  of  the  root 
with  it.  The.  Chinese  is  rounder,  as  if  the  bark  had  heen  merely  scraped  off. 

2.  The  perforations  are  different.  In  the  Russian  they  are  large, 
sometimes  only  partly  through  the  pieces.  They  are  evidently  made 
for  the  purpose  of  examining  the  condition  of  the  inner  part  of  the  root. 
In  the  Chinese  the  holes  are  small,  and  pieces  of  cord  frequently  found 
in  them.  The  insides  of  the  perforations,  too,  are  dark  colored,  and 
frequently  decayed.  The  holes  here  appear  evidently  made  simply  to 
pass  cords  through,  and  not  with  a  view  to  examine  the  root. 

3.  The  texture  and  weight  are  different.  Russian  rhubarb  is  not  so 
compact  and  heavy  as  the  Chinese  —cuts  with  less  facility,  in  consequence 
of  giving  way  before  the  knife. 

4.  Color. — Russian  rhubarb  has  a  more  lively  fresh  appearance. 
Powder,  bright  yellow  ;  Chinese,  orange. 

5.  Smell  of  Russian  rhubarb  more  aromatic — taste,  pleasant. 
European  Rhubarb. — This   is   different   both    in    appearance   and   in 

effect  on  the  system,  from  the  preceding  varieties.  It  is  in  large  pieces 
— more  woody  in  its  texture — scarcely  gritty  under  the  teeth — when 
chewed  somewhat  mucilaginous,  and  only  slightly  colors  the  saliva — 
pasty  under  the  pestle,  and  its  powder  darker  colored  In  England,  this 
is  said  to  be  extensively  used  to  adulterate  the  foreign  rhubarb. 

Purity. — In  the  state  of  powder  it  is  hardly  possible  to  judge  well  of 
the  quality.  The  only  properties  by  which  any  opinion  can  be  formed, 
are  the  taste  and  color.  The  best  plan  is  to  buy  it  in  the  root  and  have 
it  pulveriszd. 

In  selecting  the  root,  those  pieces  should  be  preferred  which  "are 
moderately  heavy  and  compact — of  a  lively  yellowish  color — brittle — 
presenting,  when  broken,  a  fresh  appearance,  with  reddish  yellow  veins 
intermingled  with  white ;  odor  decidedly  aromatic,  brittle,  an  astrin- 
gent but  not  mucilaginous  taste — gritty — staining  saliva  yellow — pow- 
der bright  yellow,  or  yellow  mingled  with  orange,"  U.  S.  Disp.  When 
very  light,  rhubarb  is  usually  rotten  or  worm  eaten.  When  very  heavy 
and  compact  it  is  of  inferior  quality. 

Although  Russian  rhubarb  is  superior  to  the  Chinese,  yet  the  best 
kinds  of  this  latter  are  very  good  and  much  cheaper.  Real  Russian 
rhubarb  is  very  rarely  seen  here. 

Composition. — The  principal  constituents  of  rhubarb  are  : — 1.  Rhu- 
barberic  acid.  This  is  the  yellow,  coloring  matter  of  rhubarb.  2.  Gal- 
lic and  tannic  acids.  These  constitute  the  astringent  matter.  The  red 
veins  are  the  seat  of  this  astringent  matter.     3.   Oxalate  of  lime.     This 


CATHARTICS.  I  _'  J 

gives  tlie  gritty  taste  to  rhubarb.  In  the  different  varieties,  the  propor- 
tions of  this  differ.  In  European  rhubarb  there  is  scarcely  any,  while 
in  Asiatic  rhubarb,  Brande  found  14  per  cent.  4.  Starch.  The  pro- 
portion of  this  differs.  The  English  contains  a  large  quantity — 11  per 
cent.,  the  Asiatic  very  little.  Besides  these  it  contains  gum,  lignin, 
various  salts,  and  water. 

Rhubarb  yields  all  its  virtues  to  alcohol  and  water. 

Effects. — As  a  cathartic  this  article  is  peculiar,  in  the  fact  of  its  com- 
bining a  cathartic  and  an  astringent  operation.  In  small  doses,  it  acts 
as  a  tonic  to  the  digestive  organs,  and  proves  astringent.  In  full  doses 
it  acts  as  a  cathartic,  and  leaves  behind  it  an  astringent  effect.  In  its 
general  operation  it  is  mild,  the  only  unpleasant  effect  which  it  pro- 
duces is  griping.  The  evacuations  which  it  causes  are  faecal  rather 
than  watery.  It  promotes  secretion  moderately.  It  appears  to  act 
more  on  the  muscular  than  on  the  mucous  coat  of  the  intestines.  Al- 
though it  gripes,  it  never  produces  inflammation  of  the  bowels  like 
some  of  the  more  active  articles.  During  its  use  the  coloring  principle 
is  absorbed  and  shows  itself  in  the  urine.  Pereira  says,  the  milk  of 
nurses  using  it  purges — differs  from  aloes,  in  not  acting  so  much  on 
large  intestines. 

From  the  peculiarity  of  its  action,  it  is  suitable  only  in  certain  condi- 
tions of  the  system.  "When  the  bowels  are  relaxed,  and  when  a  pur- 
gative and  astringent  tonic  effect  is  required,  it  is  exceedingly  valuable. 
Hence  it  is  so  used  in  the  summer  complaints  of  children. 

When  free  secretion  from  the  intestines  is  required,  it  is  objection- 
able, and  in  general  in  febrile  and  inflammatory  states  of.  the  system,  it 
is  improper.  As  a  remedy  in  habitual  costiveness,  too,  it  is  objectiona- 
ble, although  in  some  cases,  where  costiveness  depends  on  laxity  of 
intestines,  it  is  good.  As  a  purgative  for  children  whose  bowels  are  apt 
to  be  debilitated  by  acid  and  flatulence,  it  is  an  excellent  article. 

Dose. — Powder,  20  to  30  grs. 

Pill. — Simple  and  compound,  vide  Pharmacopoeia. 

Mixture. — Generally  rubbed  up  with  mint  water. 

Aromatic  Syr up. — This  is  an  excellent  laxative  for  children.  Dose 
3  i  to  3  iij- 


This  drug  is  the  inspissated  juice  of  the  leaves  of  different  species  of 
the  aloe.  The  mode  of  obtaining  it  is  very  simple.  The  leaves  are  cut 
near  their  roots,  and  then  placed  with  the  cut  end  downwards.  The 
juice,  of  a  greenish  yellow  color,  readily  exudes  from  the  leaves,  in 
which  it  is  lodged  in  large  longitudinal  vessels.  It  is  then  collected 
and  evaporated  by  exposure  to  the  sun,  or  by  boiling,  until  it  becomes 


122  MATERIA   MEDICA   AND   THERAPEUTICS. 

about  the  consistency  of  honey,  when  it  is  poured  into  skins  or  cala- 
bashes. This  forms  the  purest  kind  of  aloes.  In  some  places,  the 
leaves  are  subjected  to  pressure  for  the  purpose  of  increasing  the  quan- 
tity.. In  this  way  the  real  aloetic  juice  becomes  mixed  'with  the  muci- 
laginous juice  of  the  leaves,  and  the  quality  of  the  article  is  impaired. 

In  other  places  the  leaves  are  boiled  after  the  juice  has  exuded,  and 
the  decoction  evaporated  to  a  suitable  consistence.  In  this  way  a  still 
inferior  kind  of  aloes  is  obtained. 

The  principal  varieties  of  aloes  are  the  following  :  The  Socotrine, 
pure  Hepatic  aloes,  Cape,  aloes,  and  Barbadoes  aloes. 

1.  Socotrine  Aloes. — This  is  obtained  from  the  Aloe  socotrina,  and 
comes  from  Socotra,  an  island  near  the  Straits  of  Babelmandel.  The 
greater  part  of  it  is  carried  to  Egypt,  and  thence  to  Smyrna,  from 
whence  it  is  exported.  A  good  deal  of  it,  however,  goes  to  Bombay, 
and  thence  to  Europe. 

This  comes  in  pieces  of  a  reddish  .brown  color,  sometimes  of  a  garnet 
red,  sometimes  of  a  golden  red.  The  best  pieces  have  a  smooth,  glassy, 
conchoidal  fracture,  edges  translucent;  very  good  pieces,  however, 
break  with  a  rough  fracture.  Its  taste  is  bitter,  odor  aromatic,  and  by 
no  means  disagreeable,  resembling  that  of  myrrh.  Heat  readily  melts 
it ;  and  under  the  fingers,  it  softens  like  wax.  Its  powder  is  of  ajjolden 
yellow  color. 

2.  Cape  Aloes. — This  is  the  product  of  the  Alqe^spicata,  It  comes 
from  the  Cape  of  Good  Hope.  In  mass  it  is  of  a  deep  brown  color, 
with  a  greenish  tinge;  in  thin  laminae,  it  is  red  and  transparent.  Frac- 
ture, glossy  and  resinous.  Has  a  very  strong  and  disagreeable  odor, 
without  any  aroma.     Powder  greenish  yellow. 

3.  Barbadoes  Aloes. — Product  of  Aloe  vulgaris.  Comes  from  the 
West  Indies  in  large  gourds,  weighing  from  60  to  100  pounds.  Gene- 
rally known  by  the  name  of  Hepatic  aloes.  Of  a  dark  brown  or  liver 
color;  its  fracture  generally  dull,  not  so  smooth,  nor  its  edges  so  sharp 
or  transparent  as  the  first  two  kinds.  Taste  bitter  and  nauseous. 
Odor  strong  and  nauseous,  without  any  aroma.  Powder  dull  olive 
yellow. 

Besides  these  there  is  another  kind  of  aloes — the  Caballine  or  Horse 
aloes,  ho  called  from  its  being  used  in  veterinary  practice. ~~  This  iT  a 
very  inferior  kind,  and  is  said  to  be  prepared  by  boiling  the  leaves  after 
the  better  kind  of  aloes  has  been  obtained  from  them.  It  is  opaque 
and  almost  black,  and  has  an  exceedingly  offensive  odor.  Generally 
mixed  with  sand  and  other  impurities. 

Composition. — Aloes  contains  a  bitter  principle  called  alorsin,  proba- 
bly a  compound  of  several  proximate  principles,  a  resinous  matter,  a 
trace  of  albumen,  and  an  acid,  by  some  thought  to  be  gallic. 

It  yields  its  virtues  to  both  water  and  alcohol.     It  is  almost  entirely 


CATHARTICS.  123 

dissolved  in  boiling  water,  which,  on  cooling,  deposits  the  substance 
called  resin. 

Effects. — Aloes  in  small  doses  is  stomachic,  improving  appetite  and 

assisting  digestion.  Its  action  as  a  purgative  is  peculiar,  and  it  fulfils 
certain  indications  better  than  any  other  drug. 

It  is  very  slow ;  eight,  twelve,  or  even  twenty-four  hours  elapse  before 
it  operates.  It  does  not  disorder  the  stomach,  but  on  that  organ  is 
rather  tonic.  It  acts  on  tin:  liver,  increasing  its  secretions.  It  acts 
especially  on  the  lower  intestines,  and  is  very  apt  to  produce  irritation 
in  the  rectum  and  pelvic  viscera.  It  affects  mainly  the  muscular  and 
very  little  the  mucous  coats  of  the  intestines,  producing  large',  thick, 
copious,  and  bilious  stools. 

From  these  peculiarities  of  its  operation,  the  class  of  cases  to  the 
treatment  of  which  it  is  specially  appropriate,  is  very  obvious.  When 
we  desire  to  unload  the  bowels  without  disordering  the  stomach ;  when 
the  liver  is  torpid,  and  we  wish  to  rouse  it  to  action,  without  stimulat- 
ing the  mucous  membrane ;  when  we  desire  to  remove  costiveness,  and 
yet  avoid  debilitating  either  the  system  at  large  or  the  intestinal  canal 
in  particular,  no  other  remedy  will  meet  our  wishes  with  the  certainty 
of  aloes. 

Preparations  and  modes  of  administration. — Aloes  in  substance  is 
only  given  in  pill ;  if  the  full  effect  is  desired,  10  grs.  must  be  given  ; 
to  remove  the  habit  of  costiveness,  a  much  smaller  quantity  given  in 
daily  doses  will  answer.  For  this  purpose  we  have  no  cathartic  supe- 
rior to  the  dinner  pill,  a  combination  of  aloes,  extr.  wormwood  and  gum 
mastic. 

Decoction  of  aloes  is  so  very  unpleasant,  that  though  officinal  it  is 
not  much  used.     [Except  as  enema.] 

Tinct.  aloes  cum  myrrha,  elixir  proprietatis. — This  is  a  most  excellent 
purgative  for  children ;  both  as  a  remedy  for  torpid  liver,  habitual  con- 
stipation, or  worms,  it  answers  an  admirable  purpose. 


carbo  ligni  {vegetable  charcoal). 

This  is  a  well-known  substance,  with  the  sensible  qualities  of  which 
you  are  all  familiar,  and  of  the  chemical  history  of  which  it  is  not  neces- 
sary I  should  speak. 

It  has  the  property  of  absorbing  different  erases,  and,  though  in  a 
degree  far  inferior  to  animal  charcoal,  of  destroying  the  taste  and  smell 
of  a  variety  of  animal  and  vegetable  substances,  especially  when  they 
are  putrid. 

Its  uses  in  medicine  are  various ;  but  at  present  it  is  only  to  be 
noticed  as  a  cathartic.     It   had  at  one  time  a  very  great  reputation, 

9 


124  MATERIA   MEDICA   AND   THERAPEUTICS. 

especially  in  obstinate  constipation,  in  obviating  which,  Dr.  Daniel 
says  it  will  succeed  when  mercury,  &c,  &c,  fail.  Most  late  authorities 
deny  altogether  its  powers ;  and  as  it  is  totally  insoluble,  it  is  difficult 
to  imagine  that  it  can  produce  any  other  than  mechanical  effects. 

Perhaps,  as  suggested  by  Dr.  Chapman,  it  may  produce  an  antiseptic 
effect  on  the  excretions  present  in  the  bowels,  and  thus  render  them 
less  irritating,  while  in  its  mechanical  effect  the  mass  is  evacuated.  It 
is  now  little  used  as  a  cathartic.  It  may  be  given  in  almost  any  quan- 
tity— a  tea-spoonful  is  the  usual  dose. 


JALAP. 

For  a  long  time  the  plant  supposed  to  yield  this  substance  was  the 
Convolvulus jalapa.  This  is  now  ascertained  not  to  be  the  case.  The 
plant  which  yields  it  is  Ipomcea  jalapa,  called  also  the  Ipomcea  purga. 
This  is  a  climbing  plant,  growing  native  in  Mexico.  The  jalap  of  medi- 
cine is  the  root,  and  derives  its  name  from  Jalapa,  a  place  about  which 
the  plant  grows  abundantly,  and  from  which  it  is  sent  to  Vera  Cruz  and 
thence  to  other  countries.  It  was  first  brought  to  Europe  about  A.D. 
1610. 

The  root  is  tuberose,  and  as  found  in  the  market,  the  tubers  are  either 
entire  or  cut  into  slices.  They  are  of  various  sizes,  sometimes  as  large 
as  a  man's  fist,  but  generally  much  smaller.  "When  entire,  they  are  of 
an  oval  shape,  with  pointed  extremities  and  marked  with  incisions  on 
their  surface,  evidently  made  for  the  purpose  of  drying.  They  are  solid 
and  heavy,  coveredjvith a  brown,  wrinkled  cuticle.  When  broken  they 
present  a  surface  of  a  deep  yellow  grey  color,  interspersed  with  deep 
brown  concentric  circles.     The  slices  vary  in  size  and  shape. 

\te  powder  is  of  a  pale  brownish  color,  with  a  peculiar  odor  and  a 
taste  somewhat  sweetish  and  pungent.  When  swallowed  it  affects  the 
throat  with  a  sense  of  acrimony  and  causes  a  flow  of  saliva;  when  in- 
haled it  causes  sneezing  and  coughing. 

Purity. — The  best  pieces  of  jalap  root  are  those  which  are  the  hard- 
est, most  difficult  to  pulverize,  and  which  have  the  greatest  number  of 
concentric  circles  in  the  interior.  The  inferior  or  spurious  pieces  are 
light — whitish  internally,  and  spongy  or  friable.  Jalap  is  apt  to  be 
worm-eaten.  These  animals,  however,  only  devour  the  amylaceous  and 
gummy  parts,  leaving  the  resinous  part  untouched.  This  renders  it 
stronger,  as  the  resin  is  the  active  part.  Hence  this  should  not  be  used 
for  the  powder.  For  obtaining  the  resin  it  is  equally  good.  Jalap  yields 
its  virtues  partly  to  alcohol,  partly  to  water,  wholly  to  dilute  alcohol. 

Effects. — A  very  active,  efficient,  and  safe  cathartic.  It  quickens  the 
peristaltic  action  and  promotes  intestinal  secretion.      Its  operation   is 


CATIIAUTICS.  ]  25 

generally  attended    with   nausea   and    griping.       The    evacuations    are 
watery.     The  general  effect  on  the   intestines  is  debilitating,  and  it  doe 
not  heat  or  excite  the  system  like  some  other  cathartics. 

Uses. —  In  all  cases  where  it  is  desirable  to  evacuate  thoroughly  the 
intestines,  when  torpid  and  loaded  with  mucus,  rind  especially  flic 
large  ones,  and  to  make  a  decided  impression  on  them  in  the  way  of 
intestinal  secretion,  jalap  may  be  used  with  advantage.  It  is  speedy  in 
its  operation. 

When  the  bowels  are  in  a  state  of  irritation,  or  when  hemorrhoids, 
&c.,  are  present,  it  is  objectionable. 

Forms.  Powder. — Dose  10  to  30  grs.  Generally  given  in  combina- 
tion with  calomel. 

Pulv.  Jal.  Oomp. — Pulvis  purgans ;  Jalap  1  part.  Bi-tart.  Pot.  2 
parts. 

Dose. — 40  to  GO  grs.     Much  used  in  dropsy. 

Tinct. — Seldom  used  alone  ;  sometimes  added  to  purgative  draughts 
in  doses  of  3  i  to   3  ij. 

Extract. — In  this  yon  have  a  combination  of  resin  and  gummy 
extractive.  The  resin,  however,  is  the  only  active  part.  The  advantage 
of  the  gummy  part  is,  that  it  makes  it  operate  more  mildly.  If  water 
be  not  used  you  only  get  the  resin. 

Of  the  resin  the  dose  is  from  3  to  6  grs.;  of  the  extract  10  to  20  grs. 
The  extract  is  a  dark  brown  substance,  not  used  by  itself,  but  enters 
into  the  manufacture  of  pills. 


podophyllum  peltatum — radix  {May  apple — the  rhizome). 

This  is  a  plant  common  in  almost  every  part  of  the  United  States. 
The  leaves  are  poisonous.  The  root,  the  part  used  in  medicine,  is 
smooth,  dark  brown  color,  white  within,  from  three  to  six  feet  long, 
having  an  acrid,  disagreeable  taste.  It  gives  up  its  active  principles  to 
water  and  alcohol. 

Effects. — As  a  cathartic  it  resembles  jalap,  producing  the  same 
watery  stools,  but  by  some  it  is  said  to  gripe  less  though  it  nauseates 
more. 

Dose  and  mode  of  administration  identical  with  those  of  jalap. 
h  a^rt  &  ,  fey^*^  "f^    ^  -  XV j  Xx&J^ 

Phytolacca  decandria    (the  Poke  weed — American  nightshade). 

A  common  plant  indigenous  to  this  country,  and  growing  in  every 
part  of  it  from  New  England  to  Florida.  It  is  found  in  open  woods 
and  uncultivated  fields.     It  grows  to  the  height  of  six  or  eight  feet,  and 


126  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

dividing  into  numerous  spreading  branches,  with  large  rich  leaves  and 
purple  berries.  The  root,  which  is  perennial,  is  large,  fleshy,  and 
fibrous,  dividing  into  two  or  three  branches.  The  parts  used  in  medi- 
cine are  the  root  and  the  berries.  The  root  is  the  most  powerful  and 
is  generally  used.  When  dried  it  is  of  a  yellowish  brown  color, 
without  smell,  taste  slightly  sweetish,  but  followed  by  a  sense  of  acri- 
mony.    Its  virtues  are  extracted  both  by  water  and  alcohol. 

Effects. — This  article  acts  as  an  emetic,  cathartic,  and  narcotic.  As 
an  emetic  it  has  been  said  to  resemble  ipecac,  and  by  some  it  has  been 
recommended  as  a  substitute  for  that  article.  It  differs,  however,  very 
much  from  it.  It  is  very  slow  in  its  action,  taking  at  least  an  hour 
before  it  operates,  and  after  it  once  begins  it  continues  to  vomit  for 
three  or  four  hours.  At  the  same  time  it  purges,  and  although  the 
vomiting  which  it  produces  is  mild,  yet  sometimes  narcotic  effects 
follow,  such  as  vertigo,  impaired  vision,  &c.  It  is  therefore  very 
different  from  ipecac.  In  small  doses  it  appears  to  act  as  an  alterative, 
promoting  the  secretion  of  the  liver  and  acting  moderately  on  the 
bowels. 

Form,  Dose. — 20  to  30  grs.  in  powder  as  emetic,  1  to  5  as  alterative. 
As  the  latter  it  is  used  principally  in  chronic  diseases.  A  saturated 
tincture  of  the  berries  is  also  used  in  the  country  in  rheumatism — a 
teaspoonful  three  times  a  day. 

As  a  local  application  in  the  form  of  ointment  it  is  also  used  in  Tinea 
capitis  and  other  cutaneous  affections  with  great  advantage.  3  i  of 
powdered  root  or  leaves  to   3  i  of  lard. 

The  proper  period  for  gathering  is  in  the  autumn  after  the  leaves 
have  fallen.  To  be  cut  in  thin  transverse  slices,  dried,  pulverized,  and 
kept  in  tight  bottles. 

Dr.  Taswell,  a  country  physician,  who  has  used  it  a  good  deal, 
recommends  it  to  me  very  highly.  He  says  its  action  on  the  liver  is 
very  like  calomel,  and  that  it  even  salivates.  In  combination  with 
aloes  and  gamboge  he  uses  it  as  a  cathartic.  The  pill  is  grs.  ij  aloes, 
■J-  gr.  of  each  of  the  others  ;  one  pill  is  laxative,  four  a  full  dose. 


SALINE   CATHARTICS. 

SULPHAS    SOD^E. 

This  is  the  common  Glauber's  Salts,  and  is  so  called  from  Glauber, 
by  whom  it  was  first  prepared.  It  exists  in  a  native  state  and  is  also 
prepared  artificially. 

Native  State  and  Preparation. — In  its  native  state  this  salt  is  found 
existing  frequently  in  mineral  waters,  also  in  sea  water.      It  sometimes 


CATHARTICS.  127 

effloresces  on  the  surface  of  the  ground  in    the  neighborhood  of  salt 

lakes.  Captain  I'Vaiiklin  states  that  to  1,1k;  north  of  Carlton  Bouse,  OD 
the  river  Skatchawan,  hit.  53°  20',  is  a  small  lake,  on  the  Bhore  of  wbicb, 
in  summer  time,  it  effloresces  in  the  form  of  a  white  powder  to  the 
depth  of  two  or  three  inches.*  According  to  Captain  Hall,  in  his 
"Journey  to  South  America,"  the  valley  of  Copiapo,  on  the  coast  of 
Chili,  is  covered  with  a  layer  of  this  salt  several  inches  thick.  It  has 
the  appearance  of  snow  on  the  ground. f 

The  salt  used  in  medicine  is  artificially  prepared.  It  is  generally 
obtained  during  the  processes  for  the  manufacture  of  muriatic  acid.  The 
muriatic  acid  is  obtained  from  the  muriate  of  soda,  which  is  decomposed 
by  the  action  of  sulphuric  acid.  After  the  muriatic  acid  is  separated  by 
distillation,  a  salt  remains  which  is  the  sulphate  of  soda  with  exec--  of 
acid.  For  the  purpose  of  neutralizing  this  excess  of  acid,  the  salt  is 
dissolved  in  boiling  water,  and  to  this  is  added  carbonate  of  lime.  The 
solution  is  then  evaporated,  filtered,  and  crystallized. 

Chemical  Composition. — Sulphate  of  soda  consists  of  one  equivalent 
of  sulphuric  acid,  40  ;  one  of  soda,  32  ;  and  ten  of  water,  90  =  162.  It 
contains,  therefore,  more  than  half  its  weight  of  water. 

Properties. — This  salt,  when  first  prepared,  is  in  white,  transparent 
crystals,  and  has  a  cool,  bitter,  and  nauseous  taste.  When  exposed  to 
the  air,  it  effloresces,  and  is  converted  into  an  opaque  white  powder. 
When  subjected  to  the  action  of  heat  it  undergoes  watery  fusion/};  It  is 
soluble  in  three  parts  of  cold  water  and  in  one  part  of  boiling  water. 
In  alcohol  it  is  insoluble. 

Physiological  Effects. — This  is  a  valuable  cathartic,  and  was  formerly 
much  more  extensively  used  than  it  is  at  present.  It  is  speedy  in  its 
operation,  and  acts  by  promoting  free  secretions  from  the  internal  surface 
of  the  intestinal  canal,  aud  thus  causing  copious  serous  evacuations.  It 
operates _mildly,  producing  only  a  slight  disagreeable  sensation  in  the 
stomach,  and  afterwards  transient  uneasiness  in  the  bowels.  The  great 
objection  to  it  is  its  exceedingly  nauseous  taste  and  its  consequent  offen- 
siveness  to  most  stomachs.  It  is  on  this  account,  principally,  that  it  has 
been  so  generally  superseded  by  the  sulphate  of  magnesia. 

Dose  and  Mode  of  Administration. — To  an  adult  the  dose  is  about 
one  oun&e,  dissolved  in  water.  To  disguise  the  taste,  a  portion  of  lemon 
juice  or  cream  of  tartar  may  be  added.  Like  some  other  saliues  (espe- 
cially nitre)  sulphate  of  soda  has  a  very  notable_effect_ou  the  plasma  of  the 

*  Franklin's  Journey  to  the  Polar  Sea,  p.  506. 

f  Vol.  ii.  p.  22.     Quoted  by  Dr.  Thomson  in  the  London  Dispensatory,  p.  565. 

X  Mr.  Brande  says,  "  it  sometimes  liquifies  hi  very  warm  climates,  and  therefore 
should  be  previously  dried  if  intended  for  equatorial  consumption,  it  being  only 
necessary  to  recollect  that  half  an  ounce  of  the  dried  sulphate  is  equivalent  to 
about  au  ounce  of  crystals."     Manual  of  Pharmacy,  p.  164. 


128  MATERIA   MEDICA   AND  THERAPEUTICS. 

blood,  diminishing  the  quantity  of  fibrine.  This  is  probably  not  a  uni- 
versal nor  a  very  constant  effect  of  the  salines,  still  it  is  interesting  as 
throwing  light  on  the  modus  curandi  of  these  articles  in  inflammation. 


SULPHAS    MAGNESIA. 

This  is  called  the  bitter  purging  salt.  It  is  also  known  by  the  name 
of  Epsom  salts,  from  its  having  been  first  artificially  obtained  from  the 
evaporation  of  the  water  of  the  celebrated  Epsom  Springs  in  England. 
This  was  done  by  Dr.  Grew,  in  1675. 

Native  State  and  Preparation. — This  salt  is  found  native  in  its  pure 
state,  either  in  the  forms  of  crystal  or  in  the  state  of  efflorescence.  In 
the  mercury  mines  of  Idria,  it  is  found  crystallized.  In  Andalusia  in 
Spain  large  tracts  of  land  are  covered  with  an  efflorescence  of  it  after 
floods.     It  also  exists  in  certain  caverns  in  some  of  our  Western  States. 

What  is  used  in  medicine  is  prepared  artificially  and  chiefly  from  the 
liquor  which  remains  after  the  crystallization  of  muriate  of  soda  (com- 
mon salt)  from  sea  water,  which  holds  sulphate  of  magnesia  in  solution 
along  with  muriate  of  magnesia.  By  boiling  and  evaporation,  crystals 
of  sulphate  of  magnesia  are  deposited.  The  salt  thus  found  is  not  pure, 
inasmuch  as  it  contains  muriate  of  magnesia,  in  consequence  of  which  it 
deliquesces. 

For  the  purpose  of  obtaining  it  in  a  state  of  greater  purity  another 
method  of  preparing  it  was  adopted  by  Dr.  Henry  of  Manchester,  from 
magnesian  limestone.  According  to  this  process  the  magnesian.  lime- 
stone, consisting  of  the  carbonates  of  magnesia  and  lime,  was  first  cal- 
cined for  the  purpose  of  driving  off  the  carbonic  acid  gas.  The  magnesia 
and  lime  were  then  treated  with  muriatic  acid  with  the  view  of  taking 
up  the  lime.  The  muriate  of  lime  is  thus  held  in  solution  while  the 
magnesia  is  precipitated.  The  two  are  then  separated,  and  the  magnesia 
is  converted  into  the  sulphate  by  the  addition  of  sulphuric  acid.*  Pre- 
pared in  this  way,  it  contains  no  muriate  of  magnesia,  and,  therefore, 
does  not  deliquesce. 

At  Baltimore  it  is  prepared  from  the  silicious  hydrate  of  magnesia, 
marmolite. 

Chemical  Composition. — This  salt  consists  of  one  equivalent  of  sul- 
phuric acid,  40  ;  one  of  magnesia,  20;  and  seven  of  water  63  =  123. 

Properties. — Sulphate  of  magnesia  usually  forms  small  needle-like 
crystals — white  and  transparent.  Its  taste  is  bitter  and  saline.  When 
exposed  to  the  atmosphere,  if  pure,  it  slowly  effloresces.  When  it  deli- 
quesces, it  is  owing  to  the  presence  of  muriate  of  magnesia.     It  dis- 

*  Thomson,  vol.  ii.  p.  314. 


CATHARTICS.  129 

solves  ia  its  own  weight  of  water  at   GO0,  and  in  three-fourths  of  its 
weight  of  boiling  water.     In  alcohol,  it  is  insoluble. 

Effects. — Like  those  of  sulphate  of  soda,  though  it  is  less  apt  to 
offend  the  stomach  or  gripe,  and  operates  rather  less  promptly.  It  is 
the  best  and  fur  the  most  commonly  used  of  the  saline  purgatives.  Tlie 
dose  is  from  one  to  two  ounces.  The  best  way  of  disguising  its  taste  is 
to  add  lemon  juice  to  the  solution. 

TAUTRAS    POTASS-dE    ET    SOD^K. 

This  is  commonly  called  Rochelle  salts,  from  its  having  been  first 
prepared  and  introduced  into  practice  by  an  apothecary  of  Rochelle  in 
France,  by  the  name  of  Seignette.  From  him,  too,  it  was  called  the 
salt  of  Seignette.  The  discovery  of  this  salt  was  made  in  16*72,  but  its 
composition  was  kept  a  secret. 

From  this  circumstance,  no  doubt,  it  gained  great  celebrity,  and  from 
its  being  supposed  useful  in  almost  all  complaints,  it  was  called  Sal 
polychrest,  or  the  salt  of  many  virtues.  In  1731,  the  chemical  constitu- 
tion of  it  was  ascertained  by  Bouldac  and  M.  Geoffroy. 

Mode  of  Preparation. — This  salt  is  prepared  by  simply  adding  bitar- 
trate  of  potassa  finely  pulverized  to  a  solution  of  carbonate  of  soda. 
Here  the  excess  of  acid  in  the  bi tartrate  of  potash  combines  with  the 
soda,  forming  the  tartrate  of  soda,  while  the  carbonic  acid  escapes  with 
effervescence.  In  this  way  a  double  tartrate  of  potash  and  soda  is 
formed. 

Chemical  composition. — Rochelle  salts  consists  of  two  equivalents  of 
tartaric  acid,  132;  one  of  potassa,  48;  one  of  soda,  32;  and  ten  of 
water,  90  =  302. 

Properties. — It  is  in  large,  white,  regular  crystals ;  taste,  bitter  and 
saline;  slightly  effloresces  when  exposed  to  the  air;  soluble  in  five 
parts  of  water  at  60°,  and  in  much  less  boiling  water. 

Physiological  Effects. — Similar  in  its  operation  as  a  purgative  to 
those  already  noticed.  It  is  less  unpleasant  than  most  of  the  saline 
cathartics,  but  it  is  also  less  active. 

Dose. — From  one  ounce  to  an  ounce  and  a  half  is  a  dose  for  an  adult. 

TARTRAS    POTASS^E. 

Tartaric  acid  combines  with  potash  in  two  proportions,  the  one  form- 
ing an  acidulous  salt,  bitartrate  of  potash  ;  the  other  a  neutral  salt,  tar- 
trate of  potash. 

This  last  is  commonly  called  soluble  tartar,  from  its  great  solubility 
in  water  when  compared  with  the  bitartrate,  which  is  very  insoluble. 

Mode  of  Preparation. — Soluble  tartar  is  prepared  by  taking  a  solu- 


130  MATERIA    MEDICA   AND   THERAPEUTICS. 

tion  of  carbonate  of  potash,  and  adding  to  it  bitartrate  of  potasb  reduced 
to  a  fine  powder,  and  boiling.  Here  tbe  excess  of  acid  with  bitartrate 
is  neutralized  by  the  potash,  while  the  carbonic  acid  escapes  with  effer- 
vescence.    By  a  slow  evaporation  regular  crystals  form. 

Chemical  Composition. — One  equivalent  of  tartaric  acid,  66 ;  and  one 
of  potassa,  48  =  114. 

Properties. — If  properly  prepared,  soluble  tartar  forms  in  white  crys- 
tals. As  generally  found  in  the  shops,  however,  it  is  in  a  granular 
form.  To  obtain  regular  crystals  the  evaporation  ought  to  be  slow  and 
nearly  spontaneous.  As  commonly  made,  however,  on  a  large  scale, 
the  evaporation  is  hastened  by  frequent  stirring,  which  interferes  with 
the  crystallization.  It  has  a  cool,  bitterish  taste.  In  the  form  of  crys- 
tal, it  is  soluble  in  its  own  weight  of  cold  water;  in  the  granular  form, 
it  requires  four  times  its  weight.  In  hot  water  its  solubility  is  increased. 
In  alcohol  it  is  also  soluble.  When  exposed  to  the  atmosphere  it  deli- 
quesces. 

Effects. — As  a  cathartic  this  salt  acts  mildly  yet  efficiently.  It 
causes  no  griping,  and  possesses  the  properties  of  correcting  the  griping 
effects  of  senna  and  other  cathartics.  It  operates  quietly  with  them; 
and  like  the  other  saline  cathartics,  produces  watery  evacuations  from 
the  bowels. 

Dose. — From  3  ij  to   3  j  in  any  bland  fluid.     Not  much  used. 


SUPER-TARTRAS    POTASS^E CALLED    ALSO    BI-TARTRATE ACID    TARTRATE. 

This  is  called  crystal  of  tartar  or  cream  of  tartar,  and  is  a  salt  exists 
ing  in  the  juice  of  the  grape,  and  is  deposited  in  the  form  of  a  crust  on 
the  sides  of  casks  of  wine,  during  the  slow  fermentation  which  wine 
undergoes  when  kept.  This  goes  under  the  name  of  tartar,  and  is 
either  red  or  white,  according  to  the  wine  from  which  it  is  deposited. 
By  dissolving  this  substance  in  boiling  water  and  filtering,  brown  crys- 
tals are  deposited.  The  coloring  matter  is  then  separated  by  again 
boiling  the  crystals,  and  adding  white  clay,  whites  of  eggs,  or  wood- 
ashes,  which  attract  the  coloring  matter. 

'Properties. — Crystals  of  tartar  consist  of  small,  irregular,  brittle, 
whitish  crystals.  They  are  easily  reduced  to  powder,  and  in  this  state 
are  called  cream  of  tartar.  Its  taste  is  sharp  and  very  acid,  very  spar- 
ingly soluble  in  water,  requiring  120  parts  of  cold  and  sixty  parts  of 
boiling  water  to  dissolve  it.  It  is  insoluble  in  alcohol,  which  explains  its 
deposit  from  grape  juice  when  the  vinous  fermentation  begins  and 
alcohol  is  found. 

Composition. — Potash,  1  atom,  47;  tartaric  acid,  2  atoms,  132  ;  water, 
1  atom,  9.     Total,  188. 


CATHARTICS.  LSI 

JEffectson  the  System. — This  is  a  pleasant;  cooling  Laxative.     It  requires 
to  be  taken  in  doses  from    3  i'j  to    3  j  to   produce   its  effect.      It  i-  ta 
in    solution  sweetened    with    sugar.      [This    solution    should   always  be 
made  with  boiling  water,  and  when  cold,  decanted  from  off  the  undis- 
solved lime,  <ka.     Lemon  peel  improves  the  ta  te.] 

SOLUTION    OF    THE    CITRATE    OF    MAGNESIA. 

This  pleasant  saline  cathartic  contains  an  excess  of  citric  acid,  and   i 
impregnated  with  carbonic  acid  and  sweetened  with  syrup.     Jt  is  claimed 
that  when  well   made  it  is  permanent,  but  this   is  doubtful.     Our  best 
druggists  prepare  it  only  in  small   quantities  for  immediate   use.     Its 
agreeable  taste  is  its  chief  merit. 

SULPHAS    POTASSJE. 

This  is  the  vitriolutcd  tartar.  It  was  formerly  known  by  a  great 
variety  of  names,  such  as  sal  de  duobus,  arcanum  duplicatum,  sal  poly- 
chrcst,  dr.,  <&c. 

Preparation. — The  sulphate  of  potash  is  obtained  from  the  salt  which 
remains  after  the  distillation  of  nitric  acid.  Nitric  acid  is  procured 
from  the  action  of  sulphuric  acid  upon  nitrate  of  potash.  The  nitric 
acid  is  liberated  and  distilled  off,  while  the  sulphuric  acid  unites  with  the 
potash  and  forms  a  bi-sulphate  of  potash  which  is  left  behind.  This  salt 
is  dissolved  in  boiling  water,  and  the  excess  of  acids  is  neutralized  by 
adding  carbonate  of  potash  or  lime.  By  filtration  and  evaporation  the 
sulphate  of  potash  is  obtained  in  a  crystalline  form. 

Properties. — This  salt  is  in  small,  white,  hard,  irregular  crystals.  It 
has  a  bitter  and  disagreeable  taste.  "When  exposed  to  the  air,  it  under- 
goes no  change.  It  requires  J. 6  parts  of  cold  water  and  five  jparts  of 
boiling  water  to  dissolve  it.  In  alcohol  it  is  insoluble ;  when  heated  it 
decrepitates. 

Chemical  Composition. — It  consists  of  one  equivalent  of  sulphuric 
acid,  40  ;  one  of  potash,  48  =  88.  It  contains  no  water  of  crystalli- 
zation. 

Effects. — From  its  sparing  solubility,  this  salt  acts  with  less  rapidity 
than  the  other  neutral  salts.  It  has  in  some_  cases  produced  most  vio- 
lent and  even  fatal  effects  even  in  moderate  doses.  [The  symptoms 
resembling  cholera  in  one  case  ;  death  occurred  in  two  hours.]  The 
reason  of  this  is  not  well  known. 

Doses  and  Mode  of  Administration. — The  dose  to  an  adult  is  from  one 
to  two^  drachms.  From  its  great  insolubility,  however,  it  is  seldom  given 
alone  or  in  solution — generally  in  combination  with  other  articles,  such  as 
rhubarb,  aloes,  jalap,  &c.     Given  in  combination  with  rhubarb  in  the 


132  MATERIA   MEDICA   AND   THERAPEUTICS. 

proportion  of  10  or  15  grains  of  the  former  to  5  of  the  latter.  It  is  an 
excellent  purgative  for  children  of  five  or  six  years,  in  cure  of  visceral 
obstruction. 

PHOSPHATE    OF    SODA. 

This  is  the  tasteless  purging  salt,  and  was  first  introduced  into  prac- 
tice as  a  cathartic,  by  the  late  Dr.  George  Pearson  of  London. 

Mode  of  Preparation. — It  is  obtained  by  first  calcining  common 
bones  to  whiteness.  By  this  process  the  animal  matter  of  the  bones  is 
consumed,  while  the  earthy  matter,  the  phosphate  of  lime,  remains. 
This  is  now  pulverised  and  subjected  to  the  action  of  sulphuric  acid, 
which,  combining  with  a  portion  of  the  lime,,  leaves  the  rest  in  the  state 
of  super -phosphate  of  lime.  For  the  purpose  of  separating  this  from  the 
sulphate  of  lime,  boiling  water  is  added,  which  holds  the  super-phosphate 
of  lime  in  solution.  This  is  decanted  and  partially  evaporated.  To  this 
is  then  added  a  solution  of  carbonate  of  soda.  The  soda  combines  with 
the  excess- of  phosphoric  acid,-  forming  phosphate  of  soda,  leaving  a  neu- 
tral phosphate  of  lime,  which  is  soluble,  and  is  precipitated.  By 
filtration  and  evaporation,  crystals  of  phosphate  of  soda  are  obtained 
from  the  solution.. 

Chemical  Composition. — One  equivalent  of  phosphoric  acid,  28 ;  one 
of  soda,  32  ;  and  twelve  of  water,.  108  =  168. 

Properties. — Phosphate  of  soda  forms  in  large  transparent  crystals.  It 
has  a  cool  and  purely  saline  taste,  without  any  bitterness,  resembling 
common  salt.  On  exposure  to  the  atmosphere  it  effloresces  and  falls 
into  an  opaque  white  powder.  It  is  soluble  in  four  times  its  weight  of 
cold,  and-  twice  its  weight  of  boiling  water. 

Effects. — As  a  cathartic  this  is  mild  and  efficacious.  It  has  nothing 
disagreeable  in  its  taste,  and  produces  no  nausea  or  irritation.  It  is  ex- 
ceedingly valuable,  therefore,  in  all  cases  of  delicate  health,  and  where 
the  stomach  is  weak  and  irritable.  From  the  ease  with  which  it  can  be 
disguised,  it  is  also  an  excellent  article  for  children. 

Dose. — From  3  i  to  3  ij.  The  best  mode  of  giving  it  is  in  broth  or 
gruel. 

SENNA. 

This  is  the  product  of  different  species  of  the  cassia.  The  principal 
species  are  : — Cassia  acutifolia — Cassia  obovata — Cassia  ethiopica,  and 
the  Cassia  elongata. 

1.  Cassia  acutifolia. — This  grows  in  the  valley  of  Bicharie,  near 
Syene,  upon  the  confines  of  Egypt  and  Nubia.  Two  or  three  feet  in 
height — so  called  from  the  shape  of  the  leaf,  which  is  acute  or  lance  shaped. 

2.  Cassia  obovata. — This  grows  in  Upper  Egypt,  Syria,  and  Senegal. 


CATHARTICS.  1  33 

It  lias  also  been  cultivated  for  many  years  in  different  parts  of  Europe, 
and  especially  in  Italy.     From  one  to  two  feet  high  ;  leaf  obtuse,  obovate. 

3.  Cassia  ethiopica. — Grows  to  the  south  of  Tripoli — about  eighteen 
inches  high — leaf  oval,  lanceolate. 

4.  Cassia  elongata. — Grows  in  the  southern  parts  of  Arabia,  and  in 
India.     So  called  from  the  length  of  the  leaf. 

The  leaves  furnished  by  the  foregoing  species  of  cassia,  although  they 
differ  in  some  respects,  have  certain  characteristics  in  common,  by  which 
they  may  be  distinguished  from  other  leaves  with  which  they  may  hap- 
pen to  be  mixed. 

The  characteristics  of  the  genuine  senna  leaf  are  the  following: — The 
two  sides  of  the  leaf  are  unequal  in  size  and  shape.  The  veins  or  nerves 
of  the  under  surface  of  the  leaf  are  very  conspicuous.  They  differ 
from  each  other;  in  their  shape,  some  are  acute,  some  obovate,  some 
elongated.  In  their  length,  the  acute  are  one  half  to  one  inch  in  length, 
the  obovate  are  about  the  same,  while  the  elongated  are  from  one  inch 
to  twenty  lines. 

As  found  in  commerce,  we  have  three  different  kinds  of  foreign  senna  : 
the  Alexandria,  the  Tripoli,  and  the  Indian  Senna. 

1.  Alexandria  Senna. — So  called  from  the  port  from  which  it  is  ex- 
ported. This  is  made  up  of  different  leaves,  and  the  manner  in  which 
it  is  prepared  for  exportation  is  the  following.  The  senna  plant  of  Up- 
per Egypt  yields  two  crops,  the  abundance  of  which  depends  upon  the 
periodical  rains.  The  first  is  in  September,  the  second  in  March.  When 
the  flowers  begin  to  fall,  the  plants  are  cut  and  exposed  on  the  rocks  to 
dry.  The  leaves  are  then  picked,  packed  in  bales,  and  sent  to  a  place 
called  Boulac,  the  port  of  Cairo.  This  senna  consists  chiefly  of  the 
acute-leaved.  To  the  same  place  are  sent  quantities  of  the  obovate  leaf, 
from  other  parts  of  Egypt  and  from  Syria.  These  are  then  mixed  toge- 
ther in  the  proportion  of  five  parts  of  the  acute  leaf,  three  parts  of  the 
obovate,  and  two  parts  of  the  leaf  of  another  plant,  the  Cynanchum 
oleafolium,  commonly  called  argel.  Thus  mixed,  they  are  repacked  in 
bales,  and  sent  down  to  Alexandria,  from  whence  they  are  exported. 
The  Alexandria  senna,  then,  is  made  up  of  three  different  leaves — those 
of  the  Cassia  acutifolia,  of  the  Cassia  obovata,  and  the  argel  leaves.  The 
argel  leaves  are  distinguished  from  the  true  senna  leaf  by  their  being 
longer,  by  the  absence  of  lateral  nerves,  and  by  their  sides  being  regular, 
and  terminating  at  the  same  point  on  the  petiole. 

2.  Tripoli  Senna. — So  called  from  the  place  from  which  it  is  exported. 
It  is  the  product  of  the  Cassia  ethiopica.  Resembles  very  much  in  its 
appearance  the  leaflets  of  the  Cassia  acutifolia.  They  are  somewhat 
smaller,  however,  not  so  acute,  and  the  lateral  nerves  not  so  distinct. 
Generally  this  is  unmixed  with  any  obovate  leaflets. 

3.  Indian  Senna. — There  are  two  kinds  «_f  ;enna  which  go  under  this 


134  MATERIA   MEDICA    AND   THERAPEUTICS. 

name,  viz.  the  Mecca  Senna  and  the  Tinnevelly  senna.  Both  are  the 
products  of  the  Cassia  elongata,  and  distinguished  by  the  length  of  the 
leaf.  The  first  is  the  product  of  Arabia,  and  finds  its  way  to  England 
through  India.  The  second  is  cultivated  at  Tinnevelly,  in  the  southern 
part  of  India. 

Physical  Properties. — As  already  stated,  senna  leaves  differ  in  size 
and  shape.  They  have  a  yellowish  green  color ;  odor  resembling  that 
of  tea,  with  a  viscid  and  somewhat  nauseous  taste. 

Good  senna  should  have  a  bright  fresh  color,  and  an  agreeable  green 
tea  smell.  It  should  not  be  largely  mixed  with  stalks,  seed  pods,  &c, 
nor  much  broken,  nor  very  dusty. 

Chemical  Composition. — According  to  the  most  recent  analysis,  it 
contains:  1.  CatkcixiMie.  This  is  supposed  to  be  the  active  purgative 
principle — a  }-ellowish  red  uncrystallizable  substance,  with  a  peculiar 
odor,  and  bitter,  nauseous  taste ;  three  grs.  caused  nausea,  griping,  and 
purging,  &g.  2d.  Yelloio  coloring  matter  ;  3d.  Volatile  oil  ;  4th.  Fixed 
oil  ;  5th.  Albumen;  6th.  Mucus  ;  7th.  Malate  and  tartrate  of  lime ; 
8th.  Acetate  of  potash  ;  9th.  Mineral  salts  ;  10th.  Lignin,  &c. 

The  virtues  of  senna  are  extracted  both  by  water  and  alcohol. 

Effects. — A  valuable,  certain,  and  safe  cathartic.  It  makes  a  decided 
impression  on  the  intestinal  canal,  causing  a  considerable  derivation  of 
blood  to  this  part.  Frequently  it  produces  a  good  deal  of  heat,  flatu- 
lence, and  griping.  In  proportion  to  the  degree  of  local  irritation  which 
it  causes,  the  pulse  becomes  more  or  less  excited,  and  thirst  is  produced. 
The  evacuations  produced  by  it  are  liquid  and  jellower  than  natural, 
resembling  the  color  given  to  water  by  infusing  the  leaves.  From  this 
it  has  been  inferred  that  it  operates  principally  on  the  mucous  mem- 
brane of  the  small  intestines  and  upon  the  liver,  promoting  the  secre- 
tion of  bile. 

From  the  general  operation  of  senna,  it  may  be  considered  as  one  of 
the  milder  drastics.  Although  a  very  active  article,  it  is  yet  a  safe  one. 
It  is  given  very  freely  to  children,  not  merely  without  injury,  but  with 
advantage. 

A  great  objection  to  its  use  is  its  odor.  This  to  some  is  so  offensive 
as  of  itself  to  cause  purging. 

To  obviate  the  griping  which  it  causes,  aromatics,  such  as  cardamom 
or  caraway  seeds,  are  added.  The  best  additions,  however,  are  some 
of  the  alkaline  salts  or  manna. 

From  the  peculiar  operation  of  senna,  its  uses  are  obvious ;  when  the 
bowels  are  torpid  and  when  a  decided  revulsive  operation  upon  these 
organs  is  required,  it  is  an  excellent  article.  Although  not  so  active  or 
irritating  as  some  purgatives,  it  cannot  be  used  when  any  irritation  or 
inflammation  of  the  bowels  is  present.  For  the  same  reason,  it  ought 
not  to  be  used  where  hemorrhoids  exist. 


CATHAETICS.  L3fi 

The  EasJ  tndia  senna  operates  quite  as  well  as  the  Alexandria. 

Mode  of  Administration. — Powder,  3  ss.  to  3  '-,  not  used  —  too  bnlky 
and  disagreeable. 

Tvfusion. — Senna  3  i,  coriander  seed  3  i,  water  one  [tint,  mao 
for  ;in  Iiour  and  strained.  This  is  a  form  in  common  use.  It  should  be 
prepared  only  when  wanted.  By  keeping  and  exposing  to  the  air,  the 
extract  contained  in  the  senna  becomes  oxydized,  and  is  precipitated. 
This  gripes  exceedingly,  but  docs  not  purge  Most  commonly  sulphate 
of  magnesia  is  added  to  this  infusion  with  manna.  This  is  called  the 
black  draught —  r  jj  repeated  every  two  hours.  For  a  child,  senna  3  i, 
manna   3  ss,  water   3  iii  ;  tablespoonful  every  hour. 

3.  Tincture.  Comp. — Elixir  salutis,  senna,  caraway  seed,  cardamom, 
raisins,  proof  spirit — a  stimulating,  cordial  cathartic — good  when  the 
tone  of  tli e  digestive  organs  is  impaired,  and  when  there  is  flatulency — 
good  for  intemperate,  dose   3  i,j  to    3  i. 

4.  Syrup. — Dose  for  children,   3J_t.Q   3  ". 

5.  Confection.  Lenitive  electuary. — This  was  formerly  a  good  deal 
used,  but  has  now  gone  out. of  fashion. 

CASSIA    MARYLAXDICA. 

'  Commonly  known  by  the  name  of  American  Senna.  It  is  a  tall  showy 
plant,  growing  in  most  of  the  States  south  and  west  of  Xew  York,  com- 
monly found  in  moist  situations  and  the  borders  of  streams — flowers  from 
June  to  the  latter  part  of  August.  Flowers,  bright  yellow.  The  leaves 
— the  officinal  part — are  smooth,  green  above,  yellowish  green  below, 
from  one  to  two  inches  long,  a  quarter  of  an  inch  broad,  having  the 
odor  and  smell  of  foreign  senna. 

Effects. — An  active  cathartic  very  like  foreign  senna  ;  by  some  thought 
less  active,  though  this  is  denied  by  others,  who  deem  it  fully  equal  in 
strength.  The  difference  probably  depends  on  the  different  modes  of 
collecting  and  preserving  the  leaves. 


SCAMMONT. 

This  substance  is  obtained  from  the  root  of  the  Convolvulus,  scarn- 
monia,  a  plant  growing  native  in  Syria.  It  consists  of  a  number  of 
slender  twining  stems,  fifteen  or  twenty  feet  long,  extending  along  the 
ground,  or  climbing  upon  neighboring  plants.  The  root  is  perennial, 
from  three  to  four  feet  in  length,  and  from  ten  to  twelve  inches  in  cir- 
cumference. 

The  mode  of  obtaining  Scammony  is  the  following  : — About  the 
beginning  of  June,  the  ground  is  removed  from  the  upper  part  of  the 


136  MATERIA   HEDICA   AND  THERAPEUTICS. 

root,  the  top  of  which  is  then  cut  off  in  an  oblique  direction,  about  two 
inches  below  the  origin  of  the  stems.  Small  vessels  or  shells  are  fixed 
under  the  root  in  such  way  as  to  receive  the  milky  juice  which  oozes 
from  the  cut  surface.  Each  root  furnishes  only  a  few  drachms,  and  the 
whole  of  this  flows  out  in  about  twelve  hours.  The  juice  thus  collected 
from  different  roots  is  put  together,  and  on  standing  concretes  into  solid 
masses.  This  is  the  pure  Scammony.  Generally,  however,  while  it  is 
yet  in  the  soft  state,  it  is  adulterated  by  mixing  it  with  the  expressed 
juice  of  the  stalks  and  leaves,  and  not  unfrequently  with  flour,  ashes,  fine 
sand,  and  chalk. 

As  found  in  the  market,  scammony  is  of  different  qualities,  depending 
upon  the  degree  of  adulteration.  Formerly  the  best  kind  was  called 
Aleppo  scammony,  and  the  inferior  kind  Smyrna  scammony.  These 
names  are  not  used  at  present.  The  best  kind  is  now  called  Virgin 
scammony,  and  the  inferior  kinds,  seconds^  and  thirds. 

Virgin  scammony  comes  in  amorphous  pieces  of  a  dark  color,  some- 
times covered  with  a  white  powder.  As  this  powder  effervesces  with 
hydrochloric  acid,  it  is  chalk  in  which  the  pieces  have  been  rolled. 
They  are  friable  and  break  readily  under  the  pressure  of  the  fingers? 
presenting  a  black  and  brilliant  fracture.  When  rubbed  with  the  finger, 
moistened  with  water  of  saliva,  it  forms  a  whitish  liquid  on  its  surface. 
Its  smell  is  cheesy  ;  and  its  taste,  at  first  slight,  becomes  afterwards  acrid. 

The  inferior  kinds  of  scammony  come  in  large  fiat  masses  or  cakes. 
The  better  sort,  however,  sometimes  amorphous.  Not  so  friable,  and  its 
fracture  generally  dull. 

Tests. — Good  scammony  fractures  readily  under  the  fingers ;  the 
fracture  is  dark  and  brilliant.  Its  specific  gravity,  according  to  Pereira, 
is  only  1*210 ;  if  much  heavier,  it  is  impure.  If,  on  touching  the  frac- 
tured surface  with  hydrochloric  acid,  effervescence  takes  place,  it  is  adulte- 
rated with  chalk.  If  iodine  strike  a  blue  color  in  a  decoction  of  scam- 
mony, flour  (starch)  is  present.  When  rubbed  with  the  finger,  moistened 
with  water,  a  milky  liquor  is  formed.  Ether  takes  up  80  per  cent,  (the 
resin). 

Composition. — Principal  ingredients,  gum  and  resin.  The  proportions 
vary  from  80  per  cent.,  or  even  a  little  more,  of  resin,  to  so  little  as  29 
per  cent.     That  having  the  most  resin  is  best. 

Being  a  gum  resin,  it  is  soluble  partly  in  water  and  partly  in  alcohol. 
Diluted  alcohol  dissolves  all  but  the  impurities. 

Effects. — Scammony  is  one  of  the  drastic  hydragogue  cathartics.  It 
resembles  jalap  in  its  general  action,  being,  however,  more  active  and 
more  liable  to  produce  nausea.  Generally  operates  speedily,  and 
frequently  gripes  and  causes  a  good  deal  of  local  irritation.  Its  action 
varies  with  the  state  of  the  bowels.  If  they  are  lined  with  mucus,  it 
passes  through  without  producing  much  effect. 


CATHARTICS.  1-'i7 

In  combination  its  action  is  rendered  much  milder, 

Scammony  is  useful  in  all  cases  when  it  is  desirable  to  make  a  strong 
impression  on  the  bowels.  Jn  torpid  states  of  these  organs,  it  is  a 
valuable  article.  Whenever  active  irritation  or  inflammation  of  the 
bowels  is  present  it  is  objectionable. 

Mode  of  Administration. — Powder. — This  is  given  intimately  tritu- 
rated with  gum  arabic,  starch,  or  sugar.  This  is  supposed  to  render  its 
action  milder.  Of  this  the  dose  must  vary  according  to  the  purity  of 
the  article.  Of  Virgin  scammony,  six  to  ten  grains  for  an  adult  ;  of 
the  common,  ten  to  twenty  grains.  For  a  child,  from  three  to  five 
grains. 

A  good  way  of  giving  it  is  in  the  form  of  an  emulsion  with  milk. 

Resin, — This  operates  like  the  scammony  itself,  only  in  smaller  doses 
— eight  to  ten  grains.     Has  no  advantage  over  good  scammony. 


GAMBOGE. 

This  is  the  product  of  an  unknown  tree  growing  in  Siam,  and  in  the 
island  of  Ceylon.  In  Siam,  it  is  procured  by  breaking  the  young  shoots 
and  leaves  of  the  tree,  and  collecting  in  cocoa-nutshells  the  juice,  which 
exudes  in  drops  of  a  yellow  color.  It  is  then  transferred  into  large 
earthen  jars,  where  it  remains  until  dried  to  a  proper  consistence,  when 
it  is  formed  into  rolls  and  covered  with  leaves.  Sometimes  the  juice  is 
collected  in  the  hollow  joints  of  bamboo,  and  as  it  solidifies,  the  gam- 
boge forms  into  pipes. 

As  found  in  commerce,  it  is  in  three  different  forms ;  in  solid  rollsy 
in  cylindrical  pipes,  and  in  irregular  masses.  The  two  first  are  known 
by  the  name  of  pipe  gamboge,  the  last  cake  gamboge.  The  poorest 
pieces  of  all  the  varieties  are  called  coarse  gamboge.  Pipe  is  the  best. 
Good  gamboge  is  an  opaque  substance  of  a  uniform  orange  color,  bitter, 
and  breaking  with  a  conchoidal  fracture ;  when  taken  into  the  mouth 
it  has  no  taste  at  first,  but  afterwards  leaves  an  acrid  sensation  in  the 
throat.  It  yields  a  powder  of  a  bright  yellow  color.  The  inferior  kinds 
are  harder,  the  fracture  is  earthy,  and  of  a  brownish  not  uniform  color; 
has  dark  spots  in  it  from  the  presence  of  foreign  bodies;  generally 
adulterated  with  starch,  fragments  of  wood,  etc. 

Tests  of  its  Purity. — 1.  The  peculiar  fracture.  2.  If  a  decoction  of 
its  powder  be  tested  with  tinct.  of  iodine,  if  rendered  green,  starch  is 
present. 

Composition. — The  best  analysis  of  this  article  is  that  of  Professor 
Christison.  According  to  him  the  purest?  kind  consists  of  Resin.  This 
he  calls  gambogin  or  gambogic  acid,  a  brittle  substance  in  thin  layers  of 
a  deep  orange  color  insoluble  in  water,  but  soluble  in  alcohol  and  more 


138  MATERIA    MEDICA   AND   THERAPEUTICS. 

so  in  ether.  In  doses  of  5  grs.  this  acid  produced  free  watery  dis- 
charges; without  griping  or  uneasiness.  He  infers  from  this  that  the 
activity  of  gamboge  does  not  depend  entirely  ©n  this  acid,  for  if  it  did 
5  grs.  of  it  would  be  equal  to  7  of  gamboge,  which  is  not  the  case. 
Soluble  gum  or  arabin,  analogous  to  gum  arabic.  Woody  fibre,  only  a 
trace.     Moisture. 

The  proportions  of  these  ingredients  in  the  different  kinds  of  the 
article  are  found  to  vary  very  much. 

The  inferior  kinds  contain  large  proportions  of  woody  fibre  and 
starch. 

Gamboge  is  dissolved  partly  by  alcohol  and  partly  by  water.  It  is 
also  dissolved  by  the  successive  action  of  ether  and  water. 

Effects. — Gamboge  is  a  powerfully  hydragogue  cathartic,  promoting 
intestinal  and  urinary  secretion,  and  producing  liquid  evacuations  from 
the  bowels.  In  larger  closes  it  causes  nausea,  vomiting,  griping,  and 
copious  watery  stools.  Sometimes  it  causes  great  irritation  of  the 
mucous  membrane  of  the  intestines.  In  over  doses  it  acts  as  an  acrid 
poison. 

The  peculiarities  of  this  article  are,  that  it  is  very  apt  to  affect  the 
stomach.  This  is  owing  to  its  easy  solubility  in  the  juices  of  that 
organ,  and  that  it  operates  very  rapidly. 

It  may  be  used  in  all  those  cases  where  we  want  an  active  cathartic 
to  produce  copious  watery  evacuations.  In  cases  where  the  bowels  are 
irritable,  or  where  there  is  general  debility,  it  is  dangerous.  This  is 
one  of  the  articles  which  entered  into  the  composition  of  Morrison's 
pills,  which  have  done  so  much  mischief. 

Doses,  &c. — From  the  general  propensity  which  gamboge  has  to 
affect  the  stomach  from  its  ready  solubility,  the  best  form  of  giving  it  is 
that  of  pill,  and  in  small  doses,  frequently  repeated.  Give  a  pill  of  1, 
2,  or  3  a;rs.  every  three  or  four  hours  till  it  operates ;  a  full  dose  is 
from  3  to  6  grs.  Gamboge  is  generally  given  in  combination  to 
quicken  the  action  of  other  articles. 

Pil.  Camb.  Comp.,  in  which  the  gamboge  is  combined  with  aloes, 
carb.  potass.,  and  soap,  is  a  good  cathartic  in  dropsy  and  congestion  of 
the  brain. 

[helleborus  niger  (black  hellebore — the  root). 

Hellebore  was  well  known  to  the  ancients,  and  its  use  by  Melampus 
(b.c.  1400)  is  the  earliest  instance  on  record  of  the  giving  of  a  purga- 
tive. Dr.  Sibthorp,  however,  supposes  that  the  ancients  used  the  H. 
officinalis  not  the  H.  niger.  The  root  consists  of  rhizome  and  radicles  ; 
taste  acrid  and  nauseous. 

Effects. — Hellebore  is  an  acrid,   narcotico-irritant   purgative,   useful 


CATHARTICS.  189 

only  in  torpid,  phlrgmatic  Iialiits,  and  where  the  pelvic  circulation  is 
languid.  Though  much  lauded  by  the  ancients,  especially  in  mania,  it, 
is  now  little  used. 

Forms. — Powder. — Dose,  10  grs. 

Tincture  U.  S. — [Hellebore,  ~  iv  ;  dilute  alcohol,  Oij.  Macerate 
seven  days  and  strain.]     Dose,  3  i.] 


COLOCYNTII. 

The  plant  yielding  this  is  the  CUrullus  colocynthis,  the  Bitter  in- 
cumber; native  in  Japan,  Turkey,  Nubia,  the  Cape  of  Good  Hope,  and 
the  Grecian  islands.  In  Spain  it  is  cultivated.  It  is  an  annual  plant, 
resembling  very  much  the  common  garden  cucumber.  The  stems  are 
trailing  and  beset  with  rough  hairs.  The  fruit  which  it  yields  is  a 
round  berry,  about  the  size  of  a  common  orange,  with  a  smooth  skin  of 
a  yellow  color.  Inside  it  has  a  white  spongy  pulp  rilled  with  seeds.  It 
is  this  pulp  which  is  used  in  medicine.  The  mode  of  preparing  it  is  to 
peel  the  fruit  when  yellow  and  ripe,  and  dry  it  in  stoves.  In  this  state 
it  is  exported.  As  found  in  the  shops,  it  is  in  the  state  of  the  dried 
round  fruit,  generally  peeled.  The  pulp  is  light  and  spongy,  of  a  white 
color,  and  filled  with  seeds.  It  is  destitute  of  smell,  but  has  an  exceed- 
ingly bitter  and  nauseous  taste.  The  only  part  of  the  fruit  possessing 
active  properties  is  the  pulp. 

The  powder  is  of  a  pale  yellow  color. 

Comjjosition. — Colocynth  contains  a  peculiar  bitter  principle,  called 
colocyntin.  This  is  a  resinous  substance  of  a  yellowish  color,  extracted 
by  alcohol.  It  is  brittle  and  exceedingly  bitter.  In  alcohol  it  is  very 
soluble ;  in  water,  sparingly  so,  imparting  to  that  fluid,  however,  an 
intense  bitterness.  This  substance  possesses  the  active  properties  of 
the  colocynth  in  a  concentrated  form.  In  doses  of  one  or  two  grains, 
it  is  said  to  be  a  good  substitute  for  croton  oil. 

Besides  this,  colocynth  contains  a  resinous-matter,  insoluble  in  ether ; 
fixed  oil,  extractive  matter,  gum,  and  various  salts. 

The  virtues  of  colocynth  are  extracted  by  ether,  alcohol,  and  water. 

Effects. — In  small  doses,  colocynth  acts  as  a  safe  and  valuable  cathar- 
tic, increasing  the  peristaltic  action  of  the  intestines,  and  promoting 
intestinal  secretion.  In  full  doses,  it  acts  as  a  drastic  and  hvdrao'oo-ue, 
causing  watery  evacuations,  severe  irritation,  griping,  and  sometimes 
bloody  stools.  It  appears  to  pass  rapidly  over  the  small  intestines,  and 
to  exert  its  principal  effect  on  the  large  ones.  If  given  in  too  large 
doses  it  has  prov^cTTatal,  producing  the  effects  of  a  narcotico-acrid 
poison.  Analogous  in  its  general  operation  to  gamboge,  except  that 
gamboge  operates  more  on  the  small  iutestines.      Resembles,  aloes  in 

10 


140  MATERIA   MEDICA   AND   THERAPEUTICS. 

acting  on  the  large  intestines,  but  differs  from  it  in  producing  more 
secretion,  and  being  less  tonic. 

Dose. — 2  to  8  grains  in  powder,  mixed  with  gum  or  starch.  Seldom, 
however,  given  in  this  way.  Generally  in  form  of  extract,  and  in  com- 
bination. .  CUbi-Ui    ^J^JLMA^^iy^j-f   1  yr-JjUAAJtE?*^- 

Ex.  Colocynthidis  Com}). — Is  a  very  popular  and  a  very  active  ca- 
thartic, much  used  in  obstinate  constipation.     *^"  ■''   * ,   , 

ELATERIUM. 

The  plant  which  yields  this  article  is  the  Mormodica  elaterium.  It 
was  known  to  and  used  by  Hippocrates.  The  common  name  is  the 
wild  or  squirting  cucumber.  It  is  an  annual,  growing  native  in  the 
.south  of  Europe,  especially  in  Sicily,  Italy,  and  the  south  of  France,  in 
uncultivated  and  stony  situations.  In  England,  it  is  cultivated  exclu- 
sively for  medicinal  purposes.  In  that  climate,  however,  it  does  not 
.survive  the  winter.  The  root  of  the  plant  is  thick  and  fleshy,  sending 
out  trailing  stems  spreading  in  different  directions,  resembling  those  of 
the  common  cucumber.  Its  fruit,  also,  resembles  that  of  the  common 
-.cucumber,  only  being  much  smaller.  It  is  about  tvvo_  inches  long  and 
one  inch  thick,  of  a  greenish  grey  color,  and  covered  with  prickles. 
When  perfectly  ripe,  the  fruit  separates  from  the  stalk,  and  scatters  its 
seeds  and  juice  to  a  considerable  distance.  It  is  from  this  peculiarity 
that  it  derives  the  name  of  the  squirting  cucumber.  The  elaterium  of 
medicine  is  the  substance  spontaneously  deposited  by  the  juice  of  the 
fruit  when  allowed  to  stand. 

The  quality  of  the  elaterium  depends  in  a  great  measure  upon  the 
manner  in  which  it  is  prepared.  From  a  series  of  experiments  made 
by  Dr.  Clutterbuck  of  London,  it  appears  that  the  active  principle  of 
the  cucumber  resides  only  in  the  juice  which  surrounds  the  seeds.  The 
fruit  itself,  the  seeds,  as  well  as  the  stalks,  leaves,  &c,  contain  little  or 
none  of  it.  It  is  from  this,  therefore,  that  the  pure  elaterium  is  ob- 
tained. 

The  best  kind  of  English  elaterium  consists  of  thin,  slightly  curled 
flakes,  marked  with  the  impression  of  the  linen  on  which  it  has  been 
dried ;  of  a  pale,  greyish  green  color,  becoming  yellow  by  exposure ; 
verv  light  and  friable ;  taste  acrid  and  bitter,  with  very  little  odor.  It 
is  readily  reduced  to  powder.  This  is  called  E.  album.  The  inferior 
kinds  (E.  nigrum)  are  hard,  breaking  with  difficulty ;  more  curled, 
gummy,  ^.nd  dark  colored. 

Purity. — Elaterium  differs  greatly  in  its  shape  owing  to  the  mode  of 
preparation  and  actual  adulteration. 

1.  From  the  Mode  of  Preparation. — That  obtained  according  to  Dr. 


CATIIAK'I  US.  I  I  I 

Clutterbuck's  method,  from  the  juice  which  has  been  allowed  to  flow 

spontaneously  from  the  sliced  fruit,  is  the  strongest,  but  is  obtained  in 
very  small  quantity.  Where  the  juice  is  forced  out  l>y  Btrong  pressure, 
more  elaterium  is  made,  but  it  is  of  inferior  quality.  By  evaporating  the 
juice  a  still  inferior  quality  is  produced.  Then  again,  if  the  juice  from 
which  the  elaterium  is  deposited  be  suffered  to  stand  too  long  before  it 
is  separated,  a  mucilaginous  matter  subsides,  which  greatly  impairs  its 
strength.     This  renders  the  elaterium  dark  and  gummy. 

The  adulterations  are  with  chalk  and  lime,  generally  of  the  Maltese 
kind. 

Tests. — It  should  be  friable,  of  a  pale  green  greyish  color,  floating  on 
water,  not  effervescing  on  the  addition  of  diluted  hydrochloric  acid.  If 
it  does,  it  shows  the  presence  of  chalk.  If  the  acid  solution  be  neu- 
tralized by  ammonia,  gives  no  precipitate  on  the  addition  of  oxalate 
of  ammonia.  If  chalk  be  present,  throws  down  a  copious  precipi- 
tate (oxalate  of  lime).  Touched  with  the  tincture  of  iodine  gives  no 
evidence  of  presence  of  starch.     If  this  be  present  turns  it  blue. 

Chemical  Composition. — According  to  analysis  of  Mr.  Ilennel  of  Lon- 
don, elaterium  contains  in  TOO  parts,  40  parts  of  a  peculiar  crystal Iizable 
substance  which  he  calls  elaterin.  17  parts  of  green  resin,  starch  6  parts, 
woody  fibre  27  parts,  saline  matters  6  parts. 

Effects. — -Elaterium  is  among  the  most  active  of  the  hydragogue 
cathartics,  causing  free  secretion  and  copious  watery  evacuations.  If 
the  dose  be  somewhat  large  it  acts  with  great  violence,  causing  sickness 
and  vomiting,  together  with  irritation,  and  in  some  cases  actual  inflam- 
mation of  the  mucous  membrane  of  the  bowels.  From  the  local  irrita- 
tion which  it  produces,  general  febrile  excitement  is  apt  to  occur  during 
its  action  ;  the  pulse  becomes  excited,  the  tongue  and  skin  dry,  together 
with  great  thirst 

As  this  article  operates  so  powerfully,  its  use  must  be  limited  to  those 
cases  in  which  the  bowels  are  torpid,  and  where  it  is  desirable  to  excite 
a  powerfully  revulsive  action  in  the  intestines  and  to  cause  free  intestinal 
secretion. 

On  the  other  hand,  whenever  any  local  irritation  of  the  intestines  exists, 
it  ought  not  to  be  used.  In  delicate  habits,  too,  and  in  young  subjects  it 
is  improper. 

This  article  is  uncertain  and  variable  in  its  operation,  large  doses  at 
one  time  produce  little  effect,  while  small  ones  are  sometimes  followed 
by  violent  effects,  owing  either  to  difference  in  the  strength  of  the  article 
or  in  the  state  of  the  intestines. 

Mode  of  Administration. — The  best  form  is  that  of  pill,  made  with  ex- 
tract of  gentian.  The  dose  must  vary  with  the  strength  ;  of  the  best  kind 
one  sixteenth  to  one  eighth  gr.  is  sufficient ;  of  the  ordinary  kind  one 
half  a  grain ;  of  the  black  kind  2  or  3  grs.  are  sometimes  used.     The 


142  MATERIA   MEDICA   AND   THERAPEUTICS. 

dose  to  be  repeated  every  two  or  three  hours  until  the  desired  effect  is 
produced. 

Elaterin  is  crystalline,  very  bitter,  no  smell,  neither  acid  nor  alkaline ; 
insoluble  in  water  and  soluble  in  hot  alcohol.  One  sixteenth  of  a  grain 
operates  like  a  dose  of  elaterinm. 


CROTON    OIL. 

The  plant  which  yields  this  is  the  Croton  tiglium,  a  tree  growing  ten 
or  fifteen  feet  high  in  China,  Cochin  China,  Ceylon,  the  Molucca  islands, 
and  the  greater  part  of  the  East  Indies.  The  fruit  is  a  capsule  about 
the  size  of  a  filbert,  with  three  cells  divided  by  membranous  partitions, 
each  containing  one  seed.  It  is  from  the  seeds  that  the  oil  is  obtained. 
They  are  about  the  size  of  the  castor  oil  seeds ;  ^vTeweoTTaterally  they 
have  an  oblong  shape,  but  from  either  extremity  their  shape  is  four-sided, 
having  two  of  the  sides  convex  and  the  other  two  somewhat  flattened. 
The  shell  of  the  seed  is  black,  but  is  covered  with  a  soft  yellowish  brown 
epidermis.  The  kernel  is  of  a  yellowish  "oTown  color.  The  seeds  have 
no  smell ;  taste  at  first  mild  but  soon  becomes  hot  and  burning,  this  con- 
tinues for  some  time. 

The  seeds  are  imported  from  the  East  Indies  in  cases,  and  from  the 
friction  which  they  undergo  during  their  transportation  the  epidermis  is 
generally  rubbed  off.  On  their  first  introduction  into  Europe  they  were 
known  by  the  name  of  Molucca  grains. 

The  croton  seeds  are  actively  cathartic,  producing  the  effects  of  a 
hvdragogue.  This  is  the  form  in  which  this  article  is- frequently  used  in 
the  East  Indies.  The  seeds  are  first  well  dried  by  a  fire  and  the  shells 
carefully  removed.  This  is  supposed  to  correct  the  acrimony  of  the 
seeds.  They  are  then  pulverized  and  made  up  into  pills  with  honey, 
each  pill  containing  2igrs.  of  the  powder.  Two  of  these  pills  are  an 
ordinary  dose  for  an  adult.  Mr.  Marshall  says  this  dose  is  about  equal 
to  3  ss  of  jalap  or  to  grs.  vi  of  calomel.  The  stools  are  invariably 
watery  and  copious.  It  operates  without  nausea  and  griping,  except  in 
occasional  instances. 

In  Europe  and  in  this  country  the  only  preparation  that  is  used  is  the 
oil. 

Croton  Oil. — This  is  obtained  by  first  roasting  the  seeds  and  then 
separating  the  shells  ;  after  this  subjecting  them  to  strong  pressure.  In 
this  way  50  per  cent,  of  their  weight  of  oil  may  be  procured. 

The  oil  is  of  a  reddish  yellow  color,  with  a  faint  odor  and  of  an 
unctuous  thickness,  like  castor  oil.  Its  taste  is  hot  and  acrid,  leaving 
an  uneasy  feeling  in  the  mouth  and  throat,  which  continues  for  some 
hours. 


GATHABTICS.  L43 

Chemical  Composition. — Dr.  Nimmoj  who  early  investigated  the  ab- 
ject, states  the  composition  thus: — acrid  purgative  matter  10,  bland 
fixed  oil  55  =  100. 

This  acrid  matter  was  supposed  to  be  of  a  resinous  nature,  but  the 
subsequent  analysis  of  Brau.de  established  the  existence  of  a  peculiar 
principle,  crotonhi,  and  an  acid,  crotonic. 

Crototi  oil  is  soluble  in  ether,  the  fixed  and  volatile  oils.  Tn  absolute 
alcohol  cold  it  is  insoluble  but  soluble  in  hot,  from  which  it  is  again  de- 
posited on  cooling. 

Effects. — Croton  oil  is  an  active  hydragoguc  cathartic  and  operates 
with  great  rapidity,  producing  copious  watery  evacuations.  In  moderate 
doses,  although  it  operates  actively,  it  does  not  produce  much  nausea  or 
griping.  If  the  dose  be  somewhat  large,  it  occasions  considerable 
intestinal  as  well  as  general  irritation.  As  a  cathartic  it  is  suited  to 
those  cases  in  which  there  is  great  torpor  of  the  bowels  and  where  an 
active  revulsion  upon  those  organs  is  desirable.  In  children  and  feeble 
habits,  or  where  inflammation  of  the  intestines  is  present,  it  ought  not 
to  be  used.  What  is  peculiar  to  this  article  is  that  the  simple  applica- 
tion of  it  to  the  tongue,  without  swallowing,  will  cause  purging.  One 
or  two  drops  applied  in  this  way  will  operate,  and  maybe  resorted  to  in 
cases  where  the  patient  has  lost  the  power  of  deglutition,  as  in  apo- 
plexy, tetanus,  &c.     This  oil  is  variable  in  its  action. 

Mode  of  Administration. — The  ordinary  mode  is  that  of  jrill,  made  up 
with  crumbs  of  bread,  each  pill  containing  a  drop  of  the  oil.  To  an 
adult,  one  or  two  of  these  is  an  average  dose.  A  better  way  is  to  take 
a  pill  every  hour  or  two  until  the  desired  effect  is  produced. 


MERCURIAL  PURGATIVES. 

CALOMEL. 

Of  the  history  and  properties  of  this  most  important  article  I  shall 
speak  at  large  under  the  head  of  sialagogues;  I  now  refer  to  it  only  as 
a  cathartic.  In  this  respect,  it  is  peculiar  and  produces  effects  widely 
different  from  those  of  other  medicines  of  this  class.  The  peculiar  effects 
of  calomel  depend  not  upon  its  mere  cathartic  power,  but  on  its  action 
upon  the  liver  and  the  mucous  membrane  of  the  bowels.  The  chief  of 
these  peculiarities  are : — 

1st.  Its  action  on  the  mucous  membrane  is  peculiar  and  often  very  < 
salutary — increasing  the  secretion,  and  seeming  to  enable  the  membrane  | 
to  throw  off  any  viscid  mucus  with  which  it  may  be  coated. 

2d.  Its  influence  on  the  liver  is  marked,  and  its  cathartic  operation 
lias  been  by  some  attributed  to  its  increasing  the  flow  of  bile. 


144  MATERIA   MEDICA   AND    THERAPEUTICS. 

3d.  It  is  slow,  often  taking  from  8  to  12  hours  to  produce  any  effect 
— the  motions  are  few  and  commonly  large. 

4th.  The  operation  of  calomel  is  rarely  attended  by  much  griping, 
butoften  by  nausea  and  prostration  even  to  the  extent  of  fainting. 

5th.  The  action  of  calomel  is  permanent,  and  it  does  not  leave  behind 
it  that  tendency  to  constipation  which  follows  the  use  of  many  cathartics. 

6th.  There  is  yet  another  peculiarity  in  the  operation  of  calomel  to 
which  I  wish  to  call  your  especial  attention,  and  that  is  that  when  given 
in  large  doses,  it  does  not  produce  any  corresponding  irritation.  On  the 
contrary,  it  seems  to  act  as  a  sedative  to  the  intestinal  canal.  On  this 
principle,  scruple  doses  of  calomel  have  been  given  in  dysentery  and 
other  intestinal  disorders.  The  purgative  effect  is  not  increased,  and 
the  irritation  is  lessened  by  thus  doubling  the  dose.  Its  depressing  effect 
on  the  whole  system  is  very  markedly  increased.  From  a  scruple  of 
calomel,  the  alvine  evacuations  will  be  neither  more  numerous  nor  more 
copious  than  from  six  or  eight  grains,  but  the  prostration  will  be  far 
o-reater.  Cases  are  recorded  where  by  mistake  very  large  doses  of 
calomel  have  been  taken,  3  i  or  more.  The  purgation  was  generally 
very  moderate. 

Of  late  years  immense  doses  of  calomel  have  been  given  in  Asiatic 
cholera  and  some  other  diseases. 

[Pereira  gives  some  cases  from  the  records  of  a  London  cholera 
hospital,  in  which  calomel  was  given  in  frightful  doses.  Three  drachms 
on  the  entrance  of  the  patient  into  the  hospital,  and  one  drachm  every 
hour  till  in  some  cases  20,  25,  and  30  drachms  were  given.  In  none  of 
these  cases  did  violent  irritation  or  profuse  salivation  occur.  Seventeen 
out  of  eighteen  cases  recovered.  The  patient  who  died  took  53  drachms 
in  42  hours,  without  sensible  effects.  The  best  that  can  be  said  of  this 
practice  is,  that  it  did  not  kill. — Ed^\ 

For  the  purpose  of  testing  the  effects  of  calomel  upon  the  stomach  and 
intestines,  Mr.  Annesley  instituted  some  experiments  upon  dogs  which  are 
very  curious  and  interesting.  He  took  three  healthy  dogs,  and  gave  to 
one  3  i  of  calomel ;  to  a  second,  3  ij  ;  to  a  third,  3  iij.  After  this  they 
were  tied  up  in  a  room. 

Twenty-four  hours  after  they  had  taken  the  calomel,  the  dogs  were 
all  killed ;  and  five  minutes  after  they  were  dead,  they  were  examined, 
and  the  vascularity  of  the  stomach  was  found  to  be  in  the  inverse  ratio 
of  the  calomel  which  they  had  taken,  i.  e.  in  the  dog  who  had  taken 
3  iij,  the  vascularity  was  the  least,  and  so  on.  For  the  purpose  of  com- 
paring this  with  the  condition  of  the  stomach  of  a  dog  which  had  taken 
no  calomel  at  all,  an  examination  of  another  dog  was  made,  and  here 
the  stomach  was  more  vascular  than  in  any  of  the  others.  From  these 
experiments,  Mr.  Annesley  draws  the  conclusion,  "that  the  natural  and 
healthy  state  of  the  stomach  and  intestinal  canal  is  high  vascularity,  and 


CATHARTICS.  145 

that  the  operation  of  calomel  in  large  doses  is  directly  tlie  reverse  of 
inflammatory." 

Therapeutical  Effects  of  Calomel. — Upon  the  use  of  calomel  as  a 
purgative  in  different  diseases,  so  much  was  said  in  my  geperal  remarks 
on  purgatives,  that  T  will  not  now  go  into  the  subject  in  detail.  Suffice 
it  to  say  chiefly  by  way  of  recapitulation,  that  in  fevers  and  inflamma- 
tions, whatever  be  tlie  type  of  the  former,  or  the  location  of  the  latter, 
calomel  may,  witli  the  precautions  and  restrictions  which  were  detailed 
when  I  spoke  of  purgatives  generally,  be  used  with  excellent  effect.  In 
jaundice,  too,  it  will  often  produce  the  happiest  results.  For  obstinate 
constipation  depending  on  torpor  of  the  bowels  it  may  be  also  given 
with  advantage. 


PILULA    HYDRARGYRI    {blue  pill). 

This  is  a  mercurial  purgative,  not  so  much  used  as  a  cathartic,  yet 
capable,  when  given  in  adequate  doses,  of  producing  free  purging,  with 
most  of  the  advantages  which  attend  the  operation  of  calomel. 

Of  its  pharmaceutic  history  I  shall  speak  under  the  head  of  siala- 
gogues.  Its  dose  as  a  purgative  should  be  from  15  to  20  grs.  The 
practice  of  giving  five  grs.  of  blue  pill  at  bedtime,  and  a  senna  draught 
in  the  morning,  so  highly  recommended  by  the  late  Dr.  Abernethy,  has 
lost  some  of  its  favor  with  the  profession  ;  yet  for  a  very  large  class  of 
cases  of  constipation  it  is  of  great  value.  Blue  pill  is  an  excellent  pur- 
gative for  children ;  five  grs.  given  at  night  will  commonly  operate  in 
the  morning;  and  its  influence,  if  given  early  in  the  febrile  and  inflam- 
matory affections  of  children,  is  usually  most  salutary. 


COMBINATION    OF    CATHARTICS. 

In  what  has  been  said  of  individual  cathartics  I  have  confined  myself 
to  a  notice  of  the  effects  which  they  produce  when  given  separately, 
and  I  have  done  this  with  the  twofold  design  of  showing- that  all  cathar- 
tics do  not  act  precisely  alike,  and  to  enable  you  to  understand  the  prin- 
ciples upon  which  they  are  combined  in  our  ordinary  prescriptions.  On 
this  account  I  have  omitted  saying  anything  in  relation  to  these  combi- 
nations until  the  present  time.  After  stating  briefly  the  object  to  be 
attained  by  uniting  different  cathartics  in  one  prescription,  I  shall  ana- 
lyse the  whole  of  them  with  the  view  of  illustrating  the  principles  upon 
which  these  combinations  should  be  made. 

1.  The  first  object  to  be  attained  by  combining  cathartic  medicines  is  to 
increase  their  activity.  This  may  be  done  either  by  increasing  the  rapidity 
with  which  they  operate  or  by  increasing  the  actual  effect  produced, 


146  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

2.  The  second  object  is  to  make  them  act  more  mildly.  A  number 
of  valuable  cathartics,  you  now  know,  act  with  such  intensity  and  pro- 
duce effects  so  unpleasant,  in  the  way  of  nausea  and  griping,  when  given 
alone,  that  their  use  in  this  way  is  exceedingly  objectionable.  By  judi- 
cious combination  this  may,  to  a  very  great  extent,  be  obviated. 

3.  The  third  object  is  to  obtain  in  one  combination  the  effect  of  differ- 
ent cathartics.  As  I  have  already  stated,  these  articles  act  in  various 
ways — some  increase  the  peristaltic  motion — others  cause  copious  secre- 
tions from  the  inner  surface  of  the  intestines — while  others  again  act  by 
promoting  the  biliary  secretions.  Now  by  uniting  different  cathartics 
all  the  effects  may  be  produced  by  one  prescription. 

These  are  the  principal  objects  to  be  gained  by  combining  these  arti- 
cles, illustrations  of  which  you  will  find  in  the  notice  which  I  shall  now 
take  of  the  different  substances  belonging  to  this  class. 

Laxatives,  generally  speaking,  do  not  admit  of  combinations.  Being- 
used  for  their  mildness  and  simplicity,  they  do  not  require  anything  to 
modify  their  operation.  In  fact  as  a  general  rule,  the  best  form  in 
which  they  can  be  given  is  alone.  They  are  sometimes,  however,  com- 
bined, and  then  their  effects  are  very  much  modified. 

Castor  oil  is  best  administered  alone.  Manna  and  cassia,  from  the 
quantity  in  which  they  are  obliged  to  be  taken,  are  apt  to  sit  heavy  on 
the  stomach  and  frequently  to  cause  griping  and  uneasiness.  On  this 
account  they  are  generally  combined  with  the  more  active  purgatives, 
of  which  I  shall  speak  hereafter.  Sulphur  and  cream  of  tartar  are  fre- 
quently combined,  and  the  compound  is  more  active  than  either  sepa- 
rately. Sulphur  and  magnesia  combined  frequently  answer  an  excel- 
lent purpose.  You  have  a  gentle  laxative  suited  to  acid  states  of  the 
digestive  organs.  As  magnesia  only  operates  as  a  cathartic  when  it 
meets  with  an  acid  in  the  alimentary  canal,  its  activity  is  promoted  by 
following  it  with  cream  of  tartar. 

Of  Purgatives. — It  is  in  these  especially  that  the  advantages  of  com- 
bination are  shown. 

Senna. — This  substance,  as  already  stated,  when  given  alone  is  apt  to 
produce  a  great  deal  of  griping.  By  combining  it  with  manna  this  is 
corrected.  It  is  rendered  milder  in  its  operation,  though  not  less  effec- 
tual— at  the  same  time  all  the  unpleasant  effects  of  the  manna  when 
given  alone  are  obviated  by  the  senna.  By  combining  senna  with  some 
of  the  neutral  salts  its  griping  effects  are  also  corrected,  while  the  com- 
pound is  more  active  in  clearing  out  the  bowels  than  either  separately. 
A  very  good  combination  consists  of  senna,  manna,  and  epsom  salts.  It 
acts  thoroughly  yet  pleasantly. 

Rhubarb. — This  is  a  cathartic  which  is  given  very  conveniently  and 
advantageously  alone.  It  is  mild  in  its  operation  and  sits  easily  on  the 
stomach.     It  is  frequently,  however,  combined  with  advantage.     With 


CATHARTICS.  14  7 

magnesia  it  forms  a  very  valuable  compound,  in  all  cases  where  yon 
wish  an  antacid  effect  together  with  a' tonic  purgative.  This  is  pecu- 
liarly useful  iu  cases  of  enfeebled  and  deranged  stomach  from  over  feed- 
ing or  over  drinking.  The  most  common  combination  of  it,  however, 
is  with  calomel.  Here  you  combine  the  peculiar  operation  of  l><>t)i — 
that  of  the  rhubarb  on  the  stomach  and  intestines,  and  that  of  calomel 
on  the  liver.  With  aloes,  which  is  laxative  and  tonic,  it.  forms  ;i  us<  ful 
tonic.  It  combines  the  united  operation  of  rhubarb  on  stomach  and 
small  intestines  and  aloes  on  large. 

Jalap. — This  is  a  very  active  cathartic  and  operates  well  when  given 
alone.  Generally,  however,  it  is  combined.  With  equal  parts  of  cream 
of  tartar,  it  makes  the  pulvis  purgans  so  commonly  used.  By  this  union 
the  jalap  is  rendered  milder  and  the  whole  effect  is  •increased.  United 
with  calomel  the  double  effect  is  obtained  upon  the  liver  and  upon  the 
intestinal  canal. 

Scammony. — This  is  an  active  article  and  liable  to  gripe  when  given 
alone.  This  is  corrected  by  combination  with  other  cathartics,  and  what 
is  singular  those  of  a  very  active  character. 

By  a  union  of  Aloes,  Scammony,  and  Colocynth,  in  the  form  of  the 
compound  colocynth  pill,  you  get  a  preparation  more  permanent  in  its 
operation  than  aloes  alone,  and  yet  without  the  irritation  and  unpleasant 
effects  cither  of  scammony  or  colocynth. 

Gamboge. — This  is  a  very  active  griping  cathartic,  operating  with 
uncommon  celerity,  and  usually  when  given  alone  commencing  its  action 
in  the  stomach  and  causing  nausea  and  vomiting.  On  these  accounts  it 
cannot  well  be  given  alone.  By  combination,  however,  it  is  rendered 
a  manageable  and  valuable  cathartic.  With  aloes,  which  is  very  slow7 
in  its  operation,  and  does  not  affect  the  stomach,  it  forms  a  purgative  in 
which  the  effect  of  gamboge  on  the  stomach  and  bowels  is  corrected, 
and  yet  more  active  than  aloes  alone. 

Generally  speaking,  gamboge  is  used  only  in  small  quantities,  sav  gr. 
j.,  to  increase  the  activity  of  other  articles  when  you  want  to  produce  a 
strong  hydragogue  effect. 

JSlaterium. — This  is  generally  given  alone. 

Croton  Oil. — Generally  speaking,  this  article  has  been  used  in  its  un- 
combined  state,  and  principally  with  the  view  of  getting  the  very  active 
hydragogue  effects  which  it  produces. 

By  combination,  however,  it  may  be  made  much  more  available  as  a 
general  cathartic.  In  combination  with  Calomel  or  Blue  pill,  in  the 
dose  of  half  a  drop  to  six  or  eight  grains  of  the  latter,  its  general  efficacy 
has  been  increased,  while  the  nausea  and  griping  which  it  is  apt  to  pro- 
duce have  been  obviated.  With  the  compound  pill  of  rhubarb,  too,  it 
forms  a  good  combination. 

Neutral  Salts. — Very  commonly  these  are  given  by  themselves,  and 


148  MATERIA    MEDICA    AND   THERAPEUTICS. 

this  is  a  very  good  way  when  the  object  is  merely  to  wash  out  the  exist- 
ing contents  of  the  intestines.  Their  activity  is  considerably  increased 
by  mixing  them  together.  This  curious  fact  is  illustrated  in  some  mine- 
ral waters  (such  as  Cheltenham  salts).  Another  instance  is  in  the  sul- 
phate of  magnesia,  which  acts  with  great  effect  if  the  muriate  of  mag- 
nesia be  present. 

Of  the  combination  of  the  neutral  salts  with  senna  and  manna  I  have 
already  spoken. 

Calomel. — This  article  enters  into  a  great  number  of  combinations, 
which  it  is  unnecessary  to  enumerate.  In  all  cases  where  the  object  is 
to  promote  the  secretion  from  the  liver,  it  forms  a  useful  addition  to 
cathartics.  It  may  be  given  either  alone,  and  then  followed  in  five  or 
six  hours  by  some  quick  cathartic  to  carry  it  through  the  bowels,  such 
as  neutral  salts;,  or  it  may  be  given  in  combination  with  other  articles, 
such  as  powder  of  jalap,  rhubarb,  extract  of  butternut,  may  apple,  croton 
oil,  &c.  d'e.  In  this  way  you  get  the  combined  operation  of  calomel  on 
the  liver,  and  the  other  articles  on  the  intestines. 


enemata  {clysters). 

From  the  great  susceptibility  of  the  mucous  surface  of  the  lower 
bowels,  it  is  evident  that  medicinal  substances  may  be  applied  to  it  to 
produce  impressions  not  merely  on  the  intestine  itself,  but  on  the  sys- 
tem at  large.  Hence  enemata  are  used  for  a  great  variety  of  purposes. 
At  present  I  shall  only  speak  of  them  as  agents  intended  to  evacuate 
the  bowels,  either  by  their  own  powers,  or  by  promoting  the  operation 
of  cathartics.     Used  for  this  purpose,  they  are  of  very  great  value. 

Cathartic  enemata  operate  in  two  different  ways;  first,  by  the  mere 
stimulus  of  distension  causing  contraction  of  the  gut;  second,  by  an 
irritation  of  the  mucous  membrane  of  the  rectum,  they  stimulate  the 
muscular  coat,,  and  in  that  way  provoke  contraction.  This  impression 
is  frequently  conveyed  to  the  upper  portion  of  the  large  intestines. 
Enemata  are  capable  of  fulfilling  three  indications  : 

1.  They  evacuate  the  lower  portion  of  the  alimentary  canal. 

2.  They  assist  and  expedite  the  operation  of  cathartics. 

3.  By  the  irritation  on  the  intestine  they  act  as  revulsives,  and  thus 
relieve  distant  parts.  They  are  made  more  or  less  stimulating  according 
as  they  are  intended  for  one  or  other  of  these  purposes. 

To  evacuate  the  lower  bowels  we  use  either  those  which  act  by  mere 
distension,  or  those  which  are  only  moderately  stimulating. 

1.  Warm  water,  warm  gruel,  molasses  and  water.  These  operate  by 
distension  only.  The  quantity  to  be  given  is  from  a  pint  to  a  quart. 
Pereira  objects  very  strongly  to  the  large  enemata  recommended  by 


CATHARTICS.  1  19 

■ 

late  authors,  insisting  that  "it  is  rarely  proper  to  use  more  than  a  pint." 
That  "large  quantities  destroy  the  tonicity  of  the  gut,"  &c,  I  think 
experience  has  shown  the  entire  safety  and  manifest  utility  of  large 
enemata.  Injections  may  be  made  slightly  more  stimulating  by  adding 
to  tlie  warm  water,  salt,  oil,  or  soap.  These  are  of  course  more  efficient 
and  better  calculated  to  aid  the  operation  of  a  cathartic. 

If  a  still  more  active  enema  is  desired,  decoctions  or  infusions  of  the 
various  purgatives  may  be  used,  as  dec.  aloes,  inf.  senna',  solutions  of  the 
purgative  salts,  &c. 

If  a  strong  revulsive  action  is  required,  dec.  colocynth,  or  the  spirits 
of  turpentine  (made  into  emulsion  with  gum  arabic  or  eggs),  may  be 
tried. 

The  instrument  used,  and  the  manner  of  using  it,  are  by  no  means 
indifferent  matters.  The  best  instrument  is  the  valve  syringe,  but  the 
ordinary  enema  syringe,  if  good,  will  answer  very  well  with  care.  The 
tube  or  bag  to  which  a  pipe  is  attached,  and  from  which,  the  pipe  being 
introduced  into  the  rectum,  the  fluid  is  allowed  to  run  by  its  own  gravity, 
has  the  great  advantage  that  it  is  impossible  to  do  any  harm  with  it. 
The  common  pipe  and  bladder  are  unhandy,  but  safe.  The  fluid  should 
be  injected  very  gradually,  and  the  greatest  care  taken  to  avoid  injuring 
the  parts  with  the  pipe. 

[Moving  the  bowels  every  day  with  a  large  enema  of  cold  water  has 
cured  very  many  cases  of  chronic  piles.  It  should  be  continued  for  a 
year,  and  resumed  on  any  return  of  the  difficulty.  Even  where  cure  is 
not  effected,  the  comfort  of  the  patient  is  much  increased.] 


ANTHELMINTICS. 


Anthelmintics  are  those  medicinal  substances  which  possess  the 
power  of  destroying  and  expelling  worms  from  the  human  system. 

I  shall  first  give  you  a  brief  account  of  some  of  the  different  kinds  of 
worms  which  are  found  infesting  the  human  body.  They  may  be 
divided  into  two  general  classes,  viz.  those  which  infest  the  intestinal 
canal,  and  those  which  are  found  in  other  parts  of  the  body.  I  shall 
treat  of  the  first  of  these  only. 

Of  those  Worms  which  infest  the  Intestinal  Canal. — These  are  of  five 
species,  three  possessing  an  alimentary  canal,  hence  called  hollow  worms,' 
Coelelmintha — two  having  no  abdominal  cavity,  called  solid  worms,  or 
Sterelmintha. 

The  hollow  worms — nematoid  worms — are  ascaris  lumbricoides, 
ascaris  vermicularis,  and  tricocephalus  dispar — called  respectively  the 
large  round  worm,  the  small  thread  worm,  and  the  long  thread  worm. 

The  solid  worms  are  :  Taenia  solium,  the  common  tape-worm,  and 
Bothriocephalus  latus,  the  broad  tape-worm,  formerly  called  Taenia 
lata. 

The  Tape-worm,  Tcenia. — This  is  a  very  long  worm,  made  up  of  flat 
articulations,  united  by  means  of  a  border  or  edge  varying  in  breadth 
and  thickness.  It  is  of  a  whitish  color,  and  varies  in  length  usually 
from  twenty  to  thirty  feet.  It  generally  occupies  the  small  intestines. 
Th^head  is  turned  upwards  and  firmly  insinuated  in  the  mucous  mem- 
brane, while  the  body  extends  floating  down  the  intestinal  canal.  There 
are  two  species  which  have  been  found  in  the  human  subject. 

Taenia  lata,  or,  as  it  is  now  called,  Bothriocephalus  latus — the  broad 
tape-worm.  This  species  has  been  found  chiefly  in  the  inhabitants  of 
Poland,  Switzerland,  Russia,  and  some  parts  of  France.  In  other  parts 
of  Europe  it  is  not  found.  In  this  species  the  articulations  are  broader 
than  they  are  long,  and  the  whole  worm  is  broader  and  thicker  than 
the  other  species — the  taenia  solium.  The  breadth  varies  from  one 
eighth  to  one  quarter  or  more  of  an  inch.  Its  general  length  is  from 
fifteen  to  twenty  feet.  Its  color  is  dusky  and  not  so  white  as  the  taenia 
solium. 

Tamia  Solium. — The  solitary  worm — so  called  from  its  being  sup- 
posed that  never  more  than  a  single  one  was  found  in  the  intestinal 


ANTHELMINTICS.  Id] 

canal  at  the  same  time.  Satisfactory  observations  have,  however, 
proved  this  to  bo  incorrect.  Tins  species  is  found  in  the  inhabitant  of 
Europe  generally,  with  the  exception  of  those  nations  in  whom  the 
taenia  lata  is  met  with,  in  whom  it,  is  not  often  found,  though  occasion- 
ally the  two  species  of  worm  are  found  in  the  same  individual  at  the 
same  time.  Among  the  Egyptians  it  is  also  common.  It  is  not  so 
broad  or  so  thick  as  the  other  species,  its  length  however  is  greater, 
averaging  from  twenty-five  to  thirty  feet.  Its  color  is  commonly  a  pale 
wliite.  This  species  of  ta3nia  is  never  passed  entire,  and  it  possesses 
the  curious  property  of  parting  with  a  number  of  joints  and  reproducing 
others  to  supply  their  place.  This  worm  is  Hermaphrodite,  having  a 
double  sexual  apparatus  in  each  joint. 

Ascaris  Lumbricoidcs.  The  long  round  worm.  This  animal  is  about 
the  thickness  of  a  common  quill  and  from  six  to  ten  fingers'  breadth  long. 
When  first  passed  it  has  a  transparent  appearance,  but  it  soon  acquires 
an  opaque  yellow  tinge.  The  general  shape  of  the  body  is  cylindrical, 
but  tapering  towards  the  extremities.  It  is  found  both  in  children  and 
adults;  in  the  former,  however,  it  is  most  common.  Its  natural  abode  is 
in  the  small  intestines,  more  especially  the  jejunum  and  ilium.  Occa- 
sionally it  passes  into  the  stomach  and  makes  its  way  out  by  the  mouth. 
Unlike  the  taenia  it  exists  in  great  numbers — fifty,  a  hundred,  and  even 
a  greater  quantity  having  been  discharged,  in  a  few  days-,  from  the  same 
person.     Occasionally  it  is  found  with  other  worms. 

Ascaris  Vermicularis,  also  known  by  the  name  of  Oxyuris  vermicularis 
—  the  maw  or  thread  worm.  The  common  name  by  which  they  are 
known  is  ascarides.  This  is  a  small  worm  with  an  obtuse  head,  and 
varying  in  length  from  one  line  to  five  and  six  lines.  The  part  of  the 
intestines  in  which  this  worm  is  generally  found  is  the  rectum,  sometimes 
also  in  the  colon,  and  occasionally  in  the  coecum.  In  children  and 
young  subjects  they  are  more  common  than  in  adults.  In  females  they 
are  sometimes  found  in  the  vagina,  from  whence  they  have  been  known 
to  pass  up  into  the  urinary  organs.  In  some  very  rare  cases,  they  have 
been  detected  in  the  stomach  and  oesophagus.  The  worm  is  never  found 
alone,  but  always  in  conglobate  masses.  According  to  Bura,  the  ascarides 
live  longer  in  the  human  body  than  any  other  worm. 

Tricocephalus  Dispar — thread  worm — the  long  thread  worm,  or  capil- 
lary headed  worm.  This  is  a  slender  worm  from  one  and  a  quarter  to 
two  inches  in  length,  and  in  breadth  not  more  than  about  half  a  line.  Its 
color  is  usually  white.  This  worm  is  not  of  a  uniform  size  throughout  its 
whole  length.  The  extremity  where  the  head  is  situated,  is  very  slender 
and  resembling  a  thread,  and  from  this  it  derives  its  name.  For  about  two 
thirds  of  its  length  it  continues  of  this  size.  The  remaining  one  third 
towards  the  tail  is  much  larger.  Pereira  says  "  it  does  not  appear  that 
the  long  thread  worm  ever  excites  any  symptoms." 


152  MATERIA    MEDIC  A   AND   THERAPEUTICS. 

Evidences  of  the  Existence  of  Worms. — It  is  by  no  means  easy  to  decide 
in  all  cases  whether  worms  are  actually  present.  This  arises  mainly  from 
two  causes.  In  the  first  place  they  most  commonly  occur  in  very  young 
subjects,  who,  of  course,  can  give  no  accurate  account  of  their  symp- 
toms or  sensations;  and  in  the  second  place,  the  sympathetic  irritations 
occasioned  by  worms  in  the  intestines,  are  so  diffused  over  the  whole 
svstem,  so  remote  frequently  from  the  intestines,  and  so  varied  in  their  cha- 
racter, that  it  is  not  always  easy  tp  trace  them  up  to  their  original  source. 

The  symptoms  may  be  divided  into  two  classes,  viz.  primary  and 
secondary. 

L  Primary  Sym})toms. — By  these  I  mean  the  immediate  symptoms  of 
local  irritation  in  the  intestinal  canal.  The  first  of  these  is  pain  in  the 
abdomen.  As  may  naturally  be  inferred,  from  the  moving  nature  of  the 
irritating  cause,  these  pains  are  not  fixed  in  any  particular  spot,  but 
wandering  over  the  whole  abdomen.  They  differ,  too,  in  intensity,  vary- 
ino-  from  a  mere  sense  of  uneasiness  to  pains  of  a  more  sharp  and  pricking 
character.  Whenever  the  stomach  and  intestines  are  empty,  these  pains 
are  aggravated,  and  on  taking  food  they  are  usually  relieved.  The  ab- 
domen becomes  tumid  and  tender. 

The  second  symptom  is  derangement  of  the  functions  of  the  stomach 
and  bowels.  This  exhibits  itself  in  nausea,  eructations,  and  sometimes 
vomiting.  The  appetite  is  variable — at  one  time  entirely  gone,  and  at 
another  voracious.  The  bowels  are  irregular — sometimes  costive,  some- 
times relaxed.  Not  unfrequently  tenesmus  is  present.  Such  are  the 
primary  and  local  effects  of  worms,  viz.  irritation  in  the  intestinal  canal 
and  a  consequent  derangement  of  the  function  of  digestion. 

2.  Secondary  Symp>toms. — These  are  various,  and  show  themselves  in 
almost  every  part  of  the  system. 

The  countenance  is  generally  changed  in  its  appearance.  Usually  it  is 
of  a  pale  or  leaden  color,  with  a  red  spot  on  the  cheek.  The  eye  becomes 
dull  and  frequently  fixed  ;  the  pupil  is  dilated,  and  the  under  eyelids 
become  tumid  and  have  a  bluish  streak  upon  them. 

The  nose  is  tumid,  and  itches  incessantly.  Children  are  constantly 
picking  their  noses. 

The  mouth  is  full  of  saliva ;  the  upper  lip  swollen  ;  the  tongue  foul 
and  the  breath  offensive. 

The  brain  and  nervous  system  are  also  greatly  affected.  There  is  head- 
ache, especially  after  taking  food — singing  in  the  ears.  Disturbed  sleep, 
and  vertigo.  Delirium  and  fainting  have  all  been  known  to  occur. 
Amaurosis,  deafness,  apoplexy,  and  epilepsy  have  resulted  from  the  pre- 
sence of  worms. 

The  foregoing  is  a  general  account  of  the  symptoms  indicating  the  pre- 
sence of  worms.  You  are  not  to  expect  to  meet  the  whole  of  them  in 
any  particular  case. 


ANTHELMINTICS.  IBS 

After  all,  however,  the  only  certain  Bign  is  the  actual  evacuation  of 
worms  from  the  intestinal  canal.  [And  then  we  are  uot  sure  thai  the 
previous  symptoms  have  resulted  from  worms.] 

Symptoms  produced  by  the  different  species  of  worms. — 1.  Asoarides. 
— As  those  reside  chiefly  in  the  rectum,  they  cause  an  excessive  irrita- 
tion about  the  anus,  sometimes  extending  to  the  neck  of  the  bladder. 

2.  Taenia. — As  may  naturally  be  supposed,  the  sensation  occasioned  by 
this  worm  is  peculiar.  Occasionally  pricking  or  biting  is  felt;  most  com- 
monly, however,  it  is  that  of  something  alive  and  moving.  The  abdo- 
men swells  at  intervals,  and  then  subsides,  as  it  were,  by  undulation. 
From  time  to  time,  also,  a  sense  of  coldness  pervades  the  abdominal 
viscera;  the  appetite,  is  voracious,  while  the  more  the  person  cats,  the 
thinner  he  becomes.  The  complexion  is  livid,  the  eye  is  dilated  ;  con- 
fusion of  the  head  and  vertigo.  There  is  sickness  at  stomach,  and 
sometimes  vomiting,  with  general  weakness  in  all  the  limbs,  and  frequent 
trembling  of  the  whole  body.  [These  violent  symptoms  are  by  no  means 
universal.  1  have  known  a  man  in  the  most  florid  health  pass  joints  of 
taenia.] 

3.  Lumbricoides. — The  sensation  caused  by  these  animals  is  much 
more  severe  generally  than  that  of  the  taenia.  This  arises  from  the 
greater  number  of  these  generally  present,  and  from  their  insinuating 
their  sharp  points  into  the  mucous  lining  of  the  intestines.  About  the 
umbilicus,  accordingly,  severe  colicky  pains  are  frequently  felt,  together 
with  rumbling  of  the  abdomen. 

Origin  of  Worms. — The  advocates  for  spontaneous  generation  have 
made  the  existence  and  multiplication  of  intestinal  worms  and  other 
parasites  the  great  foundation  of  their  theory.  Their  whole  argument 
amounts,  when  stripped  of  its  verbiage,  to  this.  We  do  not  well  see 
how  a  worm  can  have  got  into  the  intestines  of  a  man,  still  less  of  a 
foetus  in  utero  (where  they  have  been  found),  or  into  the  liver  or  the  eye  ; 
and  therefore  we  will  insist  that  it  did  not,  but  has  been  generated 
in  the  spot  where  we  find  it.  This  is  an  argument  not  from  our 
knowledge,  but  from  our  ignorance,  and  is  entirely  unphilosophical.  I 
need  not  tell  you  after  this,  that  I  do  not  believe  at  all  in  the  spon- 
taneous origin  of  these  animals.  However  they  may  originally  get  into 
the  human  body,  they  are  propagated  in  the. ordinary  way,  though  only 
under  certain  circumstances  of  the  human  body  are  their  germs  developed. 

Circumstances  favoring  the  development  of  worms. — These  are 
various,  and  in  a  practical  point  of  view  are  worthy  of  investigation.  A 
knowledge  of  them  is  the  only  thing  which  can  lead  to  a  correct  and 
philosophical  use  of  the  various  remedies  proposed  for  their  extermina- 
tion. 

1.  A  peculiar  condition  of  the  intestinal  canal. — The  precise  condition 
of  the  intestines  favorable  to  the  development  of  worms  is  that  in  which 


154  MATERIA   MEDICA   AND   THERAPEUTICS. 

large  accumulations  of  mucous  and  other  secretions  have  taken  place, 
and  are  found  lining  the  inner  surface. 

*  2.  Age. — It  is  a  well  known  fact  that  children  are  more  liable  to  worms 
than  adults,  and  the  reason  is  that  there  is  a  greater  tendency  in  them 
to  mucous  and  crude  accumulations  in  the  intestines.  There  are  only 
two  species  of  worms  that  children  are  liable  to,  viz.  ascarides  and 
lumbrici. 

3.  Sex. — As  a  general  rule  females  are  more  liable  than  males. 

4.  Diet. — It  is  a  fact  well  ascertained  that  certain  kinds  of  diet  are 
more  favorable  to  the  production  of  worms  than  others.  This  must 
necessarily  be  the  case.  The  too  frequent  use  of  crude  and  raw  vege- 
tables and  fruits  has  this  effect.  The  excessive  use  of  sugar,  milk,  butter, 
and  cheese,  and  abstinence  from  animal  food,  have  the  same  tendency. 

In  a  still  more  striking  manner  does  the  abstinence  from  the  use  of 
salt  produce  this  effect. 

5.  Climate. — Independently  of  mode  of  living,  the  climate  seems  to 
exercise  a  certain  infjuence  in  developing  worms.  They  are  especially 
common  in  India  and  the  western  coast  of  Africa.  I  have  already 
stated  that  the  taenia  lata  is  only  found  in  the  natives  of  the  north  of 
Europe.  Taania  solium  is  very  common  in  Switzerland.  Blacks  are 
more  obnoxious  to  worms  than  whites.     (Pereira.) 

5.  Disease. — In  fevers  worms  are  sometimes  discharged.  Now,  in 
many  cases  of  this  kind,  practitioners  have  been  in  the  habit  of  ascribing 
the  fever  to  the  presence  of  these  animals.  This  has  been  carried  too 
far.  Although  there  can  be  no  question  that  the  irritation  of  these 
animals  is  capable  of  producing  febrile  excitement  in  the  system,  yet  in 
a  great  majority  of  these  cases  their  presence  is  a  mere  coincidence,  and 
so  far  from  having  been  the  primary  cause  of  the  fever,  it  is  merely  the 
condition  of  the  system  and  of  the  intestinal  canal  occasioned  by  the 
fever  which  has  favored  their  development. 

In  debilitating  diseases  they  are  very  common.  Dr.  Isaac  Wood  of 
this  city  says  that  when  the  cancrum  oris  prevailed  endemically  at  the 
Alms  House,  the  intestines  of  such  children  as  died  of  it  were  found 
"  stuffed  full  of  worms.''''  I  believe  with  Pereira,  that  we  know  very 
little  of  the  circumstances  which  favor  or  check  the  production  of 
intestinal  worms,  and  that  Referring  their  formation  to  a  debilitated  state 
of  the  alimentary  canal  is  a  mere  hypothetical  assumption. 

PRACTICAL    RULES    TO    BE    OBSERVED    IN    THE    USE    OF    ANTHELMINTICS. 

These  are  few  and  simple,  and  directly  deducible  from  what  has 
already  been  stated. 

As  worms  are  always  associated  with  certain  conditions  of  the  system, 
and  more  particularly  of  the  intestinal  canal,  you  are  carefully  to  analyze 


ANTHELMINTICS.  155 

these.  It  is  only  by  so  doing  that  you  will  be  enabled  to  make  ;i  proper 
selection  of  the  articles  appropriate  to  any  particular  case;  and  a  in 
almost  all  cases  the  intestinal  canal  is  in  a  deranged  state,  ;i  general  rule 
is  to  begin  with  those  articles  which  shall  correct  this  condition  of  it. 
Of  course  the  first  remedies  are  active  cathartics,  and  especially  those 
that  possess  the  power  of  separating  mucus  from  the  inner  surface  of 
the  intestines,  such  as  aloes,  senna,  and  the  like.  By  these  means  alone 
you  frequently  not  merely  get  rid  of  the  worms,  but  you  correct  that 
condition  of  the  intestines  which  favors  their  propagation.  In  ca 
where  this  condition  of  the  intestines  is  accompanied  with  great  laxity 
and  debility,  tonics  are  essential,  and  it  is  here  that  iron  proves  so 
valuable. 

If  after  the  use  of  these  remedies  the  worms  still  remain,  recourse 
may  be  had  to  those  articles  which  act  more  especially  upon  these  ani- 
mals. After  the  worms  are  expelled,  endeavor  to  fortify  the  constitu- 
tion against  their  return  by  the  use  of  such  means  as  the  nature  of  the 
case  may  render  appropriate.  In  cases  of  fever  supposed  to  be  owing 
to  worms,  do  not  be  led  astray  by  importunities  of  friends  to  treat  it 
exclusively  for  these  animals. 

CALOMEL. 

Calomel  is  certainly  among  the  very  best  anthelmintics  that  we  pos- 
sess. It  acts,  probably,  simply  by  clearing  away  more  effectually  than 
any  other  medicine  the  mucus  and  other  viscid  materials  generally 
found  lining  the  intestinal  canal  in  cases  of  worms,  and  in  which  these  ani- 
mals are  always  found  imbedded.  [All  this  about  worms  imbedded  in  the 
mucus  of  the  stomach  and  bowels  is  mere  hypothesis — there  is  no  proof 
of  its  truth.]  It  should  be  given  in  such  quantities  and  so  often  repeat- 
ed, as  to  produce  its  full  effect  upon  the  whole  secretory  apparatus  of  the 
intestinal  canal,  and  this  object  should  be  accomplished  with  as  much 
rapidity  as  possible.  The  best  plan,  therefore,  is  to  give  it  in  large  doses, 
with  the  view  of  making  a  decided  impression  at  once  upon  the  intes- 
tinal canal,  and  then  following  up  its  use  by  some  active  cathartic,  for 
the  purpose  of  carrying  off  quickly  the  matters  which  may  have  been 
separated  by  the  action  of  the  calomel.  In  this  way  the  worm  is  first 
removed  from  its  bed  of  mucus,  and  then  hurried  out  before  it  has  had 
time  to  make  any  new  attachments.  It  should  never  be  carried  to  the 
extent  of  producing  salivation.  This  can  do  no  good  as  a  mere  anthel- 
mintic, and  may  do  much  injury  to  the  constitution. 

Jlode  of  Administration. — To  adults,  from  ten  to  twenty  grains,  and 
to  children,  from  three  to  five  grains,  may  be  given  at  night  on  going  to 
bed ;  to  be  followed  early  in  the  morning  by  some  active  and  quick 
purge,  such  as  castor  oil,  salts  and  senna,  <kc.     In  many  cases  a  single 

11 


156  MATERIA    HEDICA   AND   THERAPEUTICS. 

dose  will  in  this  way  prove  effectual.  If  it  should  not,  however,  it  may 
be  repeated  again  after  an  interval  of  two  or  three  nights.  [To  these 
repetitions  I  should  strongly  object.] 

Other  Cathartics. — All  cathartics,  to  a  certain  extent,  have  the  power 
of  expelling  worms.  Bitter,  nauseous,  and  drastic  purgatives  have  been 
chiefly  resorted  to  for  this  purpose.  Among  these,  senna,  aloes,  gam- 
boge, jalap,  &c,  are  the  best.  For  children,  a  very  good  article  is  the 
tincture  of  aloes  and  myrrh,  taken  in  doses  of  a  teaspoonful,  mixed  with 
sugar  and  water. 


The  preparations  of  iron  are  excellent  anthelmintics.  Of  these  the 
filings  of  iron  and  the  carbonate  are  those  commonly  used.  These  may 
be  taken  in  doses  of  from  5  to  10  grs.  two  or  three  times  a  day.  Dr. 
Bush  prescribes  from  5  to  30  grs.  every  morning  to  children  between 
one  and  ten  years  old.  The  best  plan  is  to  unite  it  in  some  cases  with 
rhubarb  in  equal  parts. 

Sulphate  of  Iron. — This  is  recommended  by  Rosenstein  as  the  best 
of  the  preparations  of  iron. 

Other  Tonics. — In  many  cases  of  worms  vegetable  tonics  may  be 
used  with  very  great  advantage.  They  are  not  in  themselves  to  be 
considered  as  at  all  destructive  to  worms,  but  they  produce  their  effects 
indirectly  by  the  tone  which  they  give  to  the  intestinal  canal  in  parti- 
cular and  to  the  constitution  at  large.  Their  use,  of  course,  is  to  be 
regulated  by  the  actual  condition  of  the  patient,  and  combined  with  the 
specific  anthelmintic  remedies. 


COLD    WATER. 

From  the  fact  that  the  tasnia,  when  plunged  into  hot  water,  moves 
with  great  vivacity,  and  on  the  contrary  when  put  into  cold  water  be- 
comes almost  asphyxiated,  Rosenstein  suggested  the  plan  of  destroying 
and  expelling  them  from  the  intestines  by  drinking  a  large  quantity  of 
cold  water  after  taking  a  purgative.  The  cold  water,  he  supposed,  would 
deprive  them  of  the  power  of  fixing  themselves  in  the  folds  of  the  intes- 
tines, while  the  purgative  in  that  state  would  bring  them  through  the 
intestines.  Several  taenia  were  actually  expelled  in  this  way.  To  give 
it  the  greatest  possible  chance  of  success  the  water  should  be  taken  as 
cold  as  possible  and  repeated  frequently.  The  addition  of  common  salt 
might  be  advantageous  in  two  ways,  by  the  specific  effect  of  the  salt 
upon  the  tasnia,  which  is  known  to  be  detrimental,  and  by  the  cooling 
effects  of  it  upon  the  water. 


ANTHELMINTICS.  157 


■cowiiaoe  (Mucuna  prurient). 

This  plant  was  long  considered  the  Dolichos  pruriens.  It  is  a  peren- 
nial, growing  native  in  the  East  and  West  Indies.  The  fruit  is  a  pod 
about  four  or  five  "inches  long,  containing  from  three  to  five  oval  scol^, 
and  thickly  covered  with  short  Stiff  brown  hairs.  These  hairs  are  the 
part  used  in  medicine.  If  incautiously  handled  they  produce  intolerable 
itching,  and  sometimes  even  inflammation  of  the  fingers.  As  an  an- 
thelmintic this  article  has  enjoyed  much  celebrity,  especially  in  the 
West  Indies,  where  it  has  been  extensively  used.  It  is  principally  in 
expelling  the  lumbrici  that  it  has  been  found  efficacious.  If  successful 
at  all  against  the  taenia  it  requires  to  be  given  in  much  larger  doses. 
The  cowhage  operates  by  the  mechanical  irritation  caused  by  the  hairs 
or  seta3  upon  the  worm  in  the  same  way  as  when  applied  to  the  human 
skin.  If  this  be  so,  it  may  be  asked  why  it  does  not  produce  similar 
effects  on  the  inner  surface  of  the  stomach  and  intestinal  canal.  This 
it  is  difficult  to  answer.  But  the  fact  is  certain  that  very  large  quanti- 
ties of  this  article  have  been  taken  without  any  unpleasant  consequences. 

Mode  of  Administration. — The  pods  are  dipped  in  syrup,  and  this 
being  scraped  off  .removes  the  hairs  with  it  When  it  is  as  thick  as 
honey  it  is  fit  for  use.  Of  this  a  child  may  take  a  teaspoonful  twice  a 
day  on  an  empty  stomach.  It  is  more  likely  to  prove  effectual  if  a 
gentle  emetic  and  a  free  purge  be  administered  a  short  time  before  it  is 
given. 

STANNUM   (Tin). 

This  metal  is  found  in  great  abundance  in  Cornwall,  in  Gallicia,  in 
Bohemia,  and  in  Sumatra.     It  is  also  said  to  have  been  found  in  Chili. 

Tin  has  a  very  slight  and  somewhat  disagreeable  taste,  and  emits  a 
peculiar  odor  when  rubbed.  The  only  form  in  which  it  is  used  in 
medicine  is  that  of  powder  or  filings. 

It  is  against  the  taenia  that  this  remedy  has  been  chiefly  used,  and  it 
has  proved  very  successful  in  the  hands  of  more  than  one  experimentalist. 
In  its  general  operation  on  the  system,  it  is  a  mild  and  safe  medicine, 
producing  no  uneasiness  of  the  stomach  or  disturbance  of  the  bowels. 
Upon  the  worms  it  does  not  exert  any  destructive  property.  It  expels 
without  destroying  them.  The  most  commonly  received  opinion  is, 
that  it  acts  mechanically. 

Mode  of  Administration. — The  only  form  in  which  tin  is  used  is  that 
of  filings  or  Umatura  stanni.  The  plan  was  first  to  purge  the  patient 
with  senna  and  manna.  On  the  next  day,  on  an  empty  stomach,  one 
ounce  of  the  powder,  mixed  in   3  iv  of  treacle,  was  administered.     On 


158  MATERIA   MEDICA   AND   THERAPEUTICS. 

the  following  clay  |  ss  more,  and  the  same  on  the  third  day.  The  day 
after  he  was  to  be  purged  again.  In  this  way  Dr.  Alston  found  it  very 
successful  against  both  taenia  and  lumbrici.  The  usual  dose  is  3  j 
to  3  ij. 

POLYPODUM  FILIX    MAS    OB    ASPIDITJM. 

This  is  the  male  fern,  a  common  perennial  plant  growing  in  Europe. 
The  root  consists  of  a  great  number  of  matted  fibres,  forming  a  sort  of 
head  of  a  blackish  color.  When  dried  it  is  without  smell.  Its  taste  is 
at  first  sweetish,  then  slightly  bitter  and  somewhat  astringent.  When 
chewed  it  is  mucilaginous.  The  part  used  in  medicine  is  the  internal 
portion  of  the  root.  The  powder  which  it  yields  is  of  a  reddish  color. 
If  kept  for  any  length  of  time  the  virtues  of  the  fern  are  lost. 

The  fern  as  an  anthelmintic  appears  to  operate  exclusively  by  its 
effects  on  the  worm  itself;  it  is  always  dead.  On  the  living  system  its 
effects  are  exceedingly  slight,  and  it  exerts  a  deleterious  influence  upon 
the  worm  without  causing  any  particular  movement  in  the  stomach  or 
intestines. 

Ordinary  mode  of  administration  is  to  give  from  3j  to  3  ij  of  the 
powder  in  electuary,  morning  and  evening,  for  two  or  three  days.  [The 
etherial  extract  (oil  of  fern)  has  been  of  late  very  much  used,  and  is  highly 
commended  by  many  good  practitioners.  The  dose  is  from  12  to  25 
drops.  It  is  usually  followed  by  a  cathartic,  though  Peschier  does  not 
think  this  necessary.] 

chenopodium  anthelminticum  ( "Wormseed  or  Jerusalem  Oak). 

An  indigenous  plant,  two  to  five  feet  high  ;  grows  in  almost  every  part 
of  the  United  States.  The  seeds,  the  part  used,  are  small,  greenish 
yellow ;  abound  in  volatile  oil ;  bitterish,  aromatic,  pungent  taste,  with 
a  peculiar  smell. 

Dose. —  3i  to  3ij  bruised,  and  mixed  with  molasses  for  a  child,  three 
or  four  years  old ;  given  night  and  morning  for  three  days,  and  followed 
by  a  cathartic. 

Oil  of  Wormseed. — 4  to  8  drops,  morning  and  evening,  for  three  days, 
followed  by  a  cathartic.  This  article  is  not  so  much  used,  though  it 
was  formerly  very  popular. 

Oil  of  Turpentine. — This  very  valuable  article  is  prepared  from  the 
concrete  juice,  consisting  of  resin  and  oil,  which  is  yielded  by  the  differ- 
ent species  of  the  pine  tree.  The  juice  exudes  either  spontaneously 
from  the  tree  or  from  incisions  made  into  it.  By  distilling  this  with 
water  in  a  common  still,  the  oil  will  be  found  swimming  on  the  surface 
of  the  water,  from  which  it  is  easily  separated. 


anthelmintics;  169 

It  is  a  limpid  colorless  fluid,  of  a  warm  sharp  taste,  and  with  a  strong 
and.  penetrating  odor.  When  swallowed,  turpentine  produces  a  sensa- 
tion of  warmth  in  the  stomach,  at  first  increasing  the  quickness  and 
force  of  the  pulse,  but  afterwards  diminishing  it,  and  if  the  dose  he  hirg<-, 
some  degree  of  nausea  is  excited,  with  slight  vertigo,  and  usually,  though 
not  always,  a  copious  discharge  from  the  bowels.  But  if  tin;  dose  be 
small,  it  acts  chiefly  on  the  kidneys.  As  an  anthelmintic  its  effects  are 
striking  and  unequivocal.  Besides  proving  actively  cathartic,  the  tur- 
pentine is  exceedingly  deleterious  to  the  worm  itself.  In  all  the  cases 
in  which  it  has  been  used,  it  has  destroyed  the  worm  before  it  was 
expelled. 

Mode  of  Administration, — As  the  object  in  the  use  of  turpentine  is 
simply  to  obtain  its  action  on  the  intestinal  canal  and  its  contents,  it 
should  be  given  in  as  large  closes  as  possible.  In  this  way  the  full  effect 
of  it  upon  the  worm  is  obtained,  and  it  passes  off  quickly  as  a  cathartic, 
without  producing  any  unpleasant  effects  upon  the  urinary  organs.  The 
dose  in  which  it  is  to  be  taken,  and  in  which  it  operates  best  for  an 
adult,  is  from  |j  to  §  ij,  taken  either  alone  or  in  peppermint.  Dr. 
Brando  says,  u  in  these  doses  the  oil  is  best  given  with  a  little  aromatic 
water  only,  or  it  may  be  blended  with  honey  or  mucilage.  It  usually 
nauseates  and  excites  eructations  from  the  stomach,  an  effect  to  a  great 
degree  prevented  by  a  little  brandy.  It  some  cases,  however,  it  has 
been  given  in  much  larger  doses,  and  without  the  least  disadvantage. 
Three  ounces,  for  instance,  have  thus  been  taken.  In  one  case  six  or 
seven  ounces  were  taken  by  a  female  for  taenia.  It  destroyed  the  worm, 
but  produced  a  severe  inflammation  of  the  rectum,  which,  however,  was 
soon  relieved  by  opium  and  injections  of  flax-seed.  The  proper  time 
for  taking  the  turpentine  is  in  the  morning,  and  on  an  empty  stomach. 
In  this  way,  it  will  generally  pass  through  the  bowels  in  an  hour  and  a 
half.  In  one  instance  it  operated  in  so  short  a  time  as  fifteen  minutes, 
bringing  away  with  it  portions  of  a  taenia,  and  in  another  an  entire  taenia 
was  discharged  in  twenty  minutes  after  it  was  swallowed.  A  child  of 
ten  years  old  may  take  3  j  with  safety,  and  an  infant  from  3  ss  to  3  j  5 
here  the  best  vehicle  is  milk. 

Against  the  lumbrici  also  turpentine  has  been  given  with  success, 
destroying  them  in  the  same  way  as  it  does  the  taenia.  As  an  injection 
against  the  ascarides,  it  is  one  of  the  best  remedies  we  possess. 


POMEGRANATE. 

This  is  the  Punica  granatum,  a  native  tree  of  Barbary  and  the  south 
of  Europe,  Arabia,  and  Persia.  In  India  and  Ceylon,  it  is  now  much 
cultivated.     In  the  Indian  Archipelago,  it  is  said  to  be  found  only  in 


160  MATERIA   MEDICA   AND   THERAPEUTICS. 

ts  cultivated  state.  From  Europe  it  was  introduced  into  the  West 
Indies,  where  it  produces  a  larger  and  a  better  flavored  fruit  than  in  its 
own  native  climates.  It  grows  to  the  height  of  eighteen  or  twenty  feet, 
and  has  a  pulpy  fruit,  about  the  size  of  an  orange.  The  part  which  has 
been  commonly  used  as  a  medicine  is  the  bark  of  the  root.  Recently, 
however,  the  bark  of  the  stem  has  been  found  equally  efficacious. 
Generally  speaking,  the  worm  is  expelled  in  from  three  to  five  hours 
after  the  remedy  is  commenced. 

Mode  of  Administration.  Decoction. — This  is  the  common  way  in 
which  it  has  been  given.  Made  by  boiling  §,ij  of  the  bark  in  one  and 
a  half  pints  of  water  down  to  three  fourths  of  a  pint.  Of  this,  when 
cold,  a  wine-glassful  is  to  be  given  every  half  hour  or  hour,,  until  four  or 
five  doses  have  been  taken. 

SPIGELIA    MARYLANDICA  (Pink  roof). 

This  plant  derives  its  name  from  the  celebrated  anatomist,  Spigelius-, 
after  whom  the  genus  was  named  by  Linnseus.  It  is  a  native  of  the 
United  States,  but  only  of  those  south  of  Virginia.  North  of  Virginia, 
it  does  not  grow  wild.     It  is  cultivated,  however,  and  grows  luxuriantly. 

In  England  it  was  first  cultivated  in  1694.  It  is  a  herbaceous  plant, 
growing  from  six  to  twenty  inches  high.  The  root  is  perennial,  consist- 
ing of  a  number  of  slender  fibres,  forming  a  large  bunch.  When  first 
taken  from  the  ground  the  fibres  are  of  a  yellow  color,  and  become 
black  on  being  dried..    This  is  the  part  used  in  medicine. 

This  article  has  an  insipid  and  somewhat  nauseous  taste.  A  large 
proportion  of  mucilage,  but  no  resin.  Its  proper  menstruum,  therefore-, 
is  water.  t  . 

Effects  on  the  System. — In  its  operation  on  the  system,  pink  root 
produces  a  double  effect :  acting  as  a  eathavtie  more  or  less  power- 
fully,, according  to  the  condition  of  the  system.  It  also  produces  a 
peculiar  narcotic  effect  on  the  nervous  system.  In  some  cases  this  has 
been  followed  by  dimness  of  vision,  dilatation  of  the  pupil,  spasms,  and 
convulsions.  The  mind,  too,  has  been  known  to  be  affected  by  it.  As  a 
general  rale,  all  these  symptoms,  however,  gradually  go>  off  without  leav- 
ing any  serious  injury  behind  them.  From  this  combination  of  proper- 
ties, it  is  not  difficult  to  conceive  how  this  article  proves  so  efficacious  as 
an  anthelmintic — acting  primarily  as  a  kind  of  narcotic  upon  the  worm, 
and  secondarily,  upon  the  intestines  as  a  laxative,  and  thus  aiding  the 
expulsion  of  the  animal. 

It  should  be  recollected,  in  using  this  article,  that  the  fresh  root  is 
much  more  potent  than  when  it  has  been  kept  for  a  time.  This  fact 
■was  noticed  by  Dr.  Gardner,  and  has  been  confirmed  by  subsequent  trials. 
Due  allowance  for  this  should,  therefore,,  be  made  in  its  administration. 


ANTHELMINTICS.  1  0 1 

Mode  of  Administration.  Infusion. — This  is  the  host  form  of  giving 
it,  and  is  prepared  by  putting  balf  an  ounce  of  the  root  to  a  pint  of 
boiling  water.  Of  this,  from  half  an  ounce  to  an  ounce  may  be  given  to 
a  child,  and  half  a  pint  morning  and  evening  to  an  adult. 

MBLIA    AZEDARECK. 

The  pride  of  India  or  pride  of  China. — A  tree  of  30  or  40  feet ;  native 
of  Syria,  Persia,  and  North  of  India,  and  cultivated  at  the  South  and 
West  of  this  country  for  ornamental  purposes  ;  at  the  South  it  is  planted 
in  cities  and  towns.  It  does  not  flourish  north  of  Virginia.  The  part 
used  is  the  bark  of  the  root,  and  the  recent  bark  is  preferable.  It  is 
emetic  and  cathartic  ;  if  given  in  considerable  quantities  proves  narcotic; 
like  the  spigelia. 

Decoction. — Four  ounces  of  fresh  baric  boiled  with  a  quart  of  water  to 
a  pint.  Of  this,  half  an  ounce  night  and  morning  to  a  child  for  three  or 
four  days,  and  then  cathartic. 


Although  not  much  known  in  regular  practice,  this  article  has  been 
long  used  as  a  vermifuge.  So  early  as  the  time  of  Celsus  it  was  recom- 
mended. In  Ireland  the  use  of  it  for  this  purpose  is  an  old  practice 
among  the  common  people.  In  the  same  way  it  is  also  much  used  in 
this  country. 

The  virtues  of  salt  as  an  anthelmintic  have  received  the  sanction  of 
the  highest  authorities.  Brera  speaks  highly  of  it.  Heberden  does  the 
same.  Rush  and  Barton  also  commend  it.  It  may  be  given  in  doses 
of  from  one  ounce  upwards,  dissolved  in  a  moderate  quantity  of  water; 
also  as  an  enema — the  best  form  ao-ainst  ascarides. 


CAMPHOR. 

Camphor  is  now  in  general  use  as  an  anthelmintic.  It  is  not  a  new 
remedy.  So  long  ago  as  the  year  1*759,  an  essay  was  written  upon  it 
by  Pringle.  On  the  worm  itself  it  would  seem  that  camphor  produces 
some  deleterious  effect,  by  asphyxiating  or  even  destroying  it.  On  the 
intestines  it  operates,  too,  very  efficaciously  in  quieting  irritation,  and 
giving  tone,  and  thus  counteracting  the  tendency  to  the  development  of 
the  verminous  germs.  Brera  and  Barton  speak  of  it  in  terms  of  high 
commendation.  It  is  against  the  lumbricoides  that  it  has  been  chiefly 
found  successful. 

Mode  of  Administration. — The  form  recommended  by  Brera  is  to 


162  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

mix  3  ss  of  camphor  and  3  i  of  gum  arabic  in  a  pint  of  water.  Of  this 
a  small  spoonful  may  be  given  at  a  time.  To  children,  to  whom  it  is 
difficult  to  administer  medicine  by  the  moutb,  it  may  be  given  in  the 
form  of  injection,  made  by  taking  one  or  more  ounces  of  the  foregoing 
solution,  and  adding  tepid  milk  according  to  the  age  of  the  patient.  It 
is  excellent  in  case  of  ascarides. 


In  the  form  of  the  mineral  solution,  or  Fowler's  solution,  this  metal 
has  been  used  with  efficacy  against  the  taenia.  Dr.  Fisher,  of  Massachu- 
setts, by  whom  it  has  been  chiefly  used,  recommends  it  as  an  article 
which  never  has  disappointed  him  in  a  single  instance.  He  directs  it 
to  be  taken  two  or  three  times  a  day  in  as  large  doses  as  the  stomach 
will  bear,  and  its  use  continued  until  the  worms  are  destroyed.  Do  not 
follow  this  practice  very  far,  or  before  the  worm  is  destroyed  the  patient 
may  be. 


The  flowers  of  the  Brayera  anthelmintica,  a  tree  about  twenty  feet 
high,  belonging  to  the  family  of  the  Rosacea?.  It  has  been  used  as  an 
anthelmintic  by  the  Abyssinians  for  more  than  two  centuries  ;  was 
mentioned  by  Bruce,  who  gave  a  good  figure  of  it.  Braver,  a  French 
physician  residing  in  Constantinople,  introduced  it  into  European 
practice,  and  from  him  it  has  its  generic  name.  The  tree  is  native  to  the 
table-land  of  North-eastern  Abyssinia.  The  part  used  in  medicine  are  the 
flowers,  which  have  been  sold  in  this  country  at  enormous  prices.  It 
has  been  employed  with  great  success  by  Chomel  and  Sandras  in  Paris, 
and  by  Budd  and  Todd  in  London.  Its  physiological  effects  are  slight ; 
nausea  and  even  vomiting  have  sometimes  followed  its  use,  but  this  is 
rare.  A  moderate  operation  on  the  bowels  is  not  uncommon.  It  is  by 
poisoning  the  worms  that  it  acts  as  an  anthelmintic.  It  has  been 
equally  successful  against  both  the  forms  of  taenia.  Dose,  half  an  ounce 
of  the  powdered  leaves  infused  in  half  a  pint  of  water;  taken  in  the 
morning  on  an  empty  stomach.  The  powder  and  infusion  should  be 
swallowed  together.  It  is  said  to  be  more  successful  when  preceded  by 
a  mild  laxative. 

[cucurbila  pepo  (Pumpkin). 

The  seeds  of  this  plant  made  into  a  paste  and  taken  in  the  morning 
fasting,  followed  in  an  hour  or  two  by  a  full  dose  of  castor  oil,  have 
of  late  been  given  with  success  in  tapeworm.  The  dose  is  one  or  two 
ounces.] 


SI  ALA  <;o  <;  i;  i;s. 


Medicines  which  excite  the  salivary  glands  and  increase  their  secre- 
tion are  called  Sialagogues. 

These  are,  according  to  their  mode  of  acting,  divided  into  topical  or 
remote.  Of  the  former,  sometimes  called  masticatories,  it  is  not  my 
intention  to  speak ;  they  are  little  used  in  medicine.  Of  the  latter,  the 
remote  sialagogues,  or  those  which  produce  a  salivary  flow  by  specific 
action,  there  is  but  one  which  by  the  certainty  and  regularity  of  its 
action  deserves  special  notice.  This  is  mercury.  The  preparations  of 
gold,  antimony,  and  iodine  sometimes  produce  this  effect;  it  has  fol- 
lowed occasionally  the  use  of  nitre  and  hydrocyanic  acid.  But  it  is  an 
exceptional  not  a  regular  or  constant  effect.  Under  this  head  then  I 
shall  speak  only  of  mercury  and  its  preparations. 


Mercury  {Hydrargyrum,  quicksilver,  called  by  the  Latins  argentum 
liquidum,  aqua  argentea,  etc.). 

Although  known  to  the  ancients,  mercury  was  not  by  them  used  as 
a  medicine.  It  is  mentioned  by  Dioscorides,  Pliny,  and  others,  but 
always  as  poisonous.  Its  first  use  as  a  medicine  has  generally  been 
credited  to  the  Arabians,  but  Dr.  Morrison  informs  us  that  it  was  used 
in  China  at  a  very  early  period,  externally  and  internally,  and  as  early 
as  A.D.  745  it  was  termed  by  them  the  elixir  of  life.  It  was  certainly 
used  externally  and  internally  by  the  Arabians  ;  its  innoxiousness  is 
expressly  asserted  by  Avicenna.  To  the  great  empiric  Paracelsus  can 
probably  be  attributed  only  the  credit  of  popularizing  what  was  pre- 
viously known.  The  power  of  mercury  to  produce  salivation  was  first 
discovered  by  a  monk  in  the  13th  century.  In  the  loth  century  it  was 
first  used  (externally)  to  cure  the  venereal  disease  by  Jacobus,  an  Italian 
surgeon.     Calomel  was  first  described  by  Crollius,  A.D.  1608. 

Except  for  the  venereal  disease,  mercury  was  not  extensively  used  till 
the  beginning  of  the  18th  century,  when  it  was  introduced  into  the  treat- 
ment of  febrile  and  inflammatory  complaints.     This  practice   took  its 


164  MATERIA   MEDICA   AND   THERAPEUTICS. 

rise  in  our  own  country,  and  it  is  to  American  physicians  that  is  mainly 
due  the  credit  of  extending  the  use  of  this  powerful  agent.  The 
circumstances  under  which  it  originated  were  the  following : — More 
than  a  century  ago  (A J).  1735)  the  American  colonies  were  desolated 
by  a  most,  fatal  epidemic  sore  throat  of  a  putrid  character.  It  first 
appeared  at  Kingston,  N.  H.,  1735,  reached  Boston  in  September, 
whence  it  progressed,  though  very  slowly,  westward,  reaching  the 
Hudson  river  in  a  little  less  than. two  years;  it  spread  over  the  whole 
country,  causing  the  most  frightful  ravages,  especially  in  New  England. 
Dr.  Douglass  of  Boston  states  that  one  fourth  of  the  inhabitants  of  that 
town  took  the  disease  and  one  in  thirty-five  died.  In  other  places  the 
proportionate  mortality  was  very  much  greater — equalling  one  sixth,  one 
fourth,  and  sometimes  one  third  of  those  attacked.  It  was  in  combating 
this  dreadful  epidemic  that  mercury  was  first  introduced  into  practice 
in  the  treatment  of  inflammatory  complaints,  and  the  credit  of  this 
great  improvement  is  due  to  Dr.  William  Douglass  of  Boston.  He 
used  calomel  and  used  it  freely.  By  Dr.  Jacob  Ogden  of  Long  Island 
the  practice  was  carried  to  a  greater  extent,  and  his  success  was,  in  his 
own  words,  "beyond  my  expectations."  He  gave  calomel  to  children 
in  doses  of  2  to  4  grains,  to  adujts  6  to  S,  repeated  every  twelve, 
eighteen,  or  twenty-four  hours.  From  the  success  which  attended  the 
use  of  mercury  in  this  disease  it  came  very  naturally  to  be  used  in 
others,  and  by  the  middle  of  the  18th  century  it  was  resorted  to  very 
frequently  in  pleurisy,  pneumonia,  &c.  &c.  When  given  as  a  cathartic 
large  doses  were  administered.  As  an  alterative,  one  or  two  grains 
were  given  combined  with  opium,  camphor,  or  antimony,  according  to 
circumstances.  From  the  foregoing  brief  sketch  of  the  origin  of  the 
mercurial  practice,  it  is  very  certain  that  it  prevailed  here  long  before 
it  was  known  in  any  other  country.  I  have  been  thus  minute,  because 
the  credit  of  this  practice  is  by  Dr.  Armstrong  claimed  for  a  Dr. 
Hamilton  who,  from  Armstrong's  account,  first  had  his  attention 
directed  to  it  in  1764,  a  period  at  which  it  was  in  very  general  use  in 
this  country. 

PHYSIOLOGICAL    EFFECTS. 

Local  Effects. — These  differ  very  much,  according  to  the  preparation 
of  this  metal  which  is  employed.  Some  of  them  appear  to  produce  little 
or  no  local  effect,  while  others  are  actively  irritant  and  caustic.  In  rela- 
tion to  calomel,  much  difference  of  opinion  has  been  expressed.  W'hile 
by  som,e  it  is  supposed  slightly  irritant,  others  consider  it  rather  as  a  local 
sedative.  [The  soothing  effect  of  calomel  ointment  and  of  dry  calomel 
on  irritable  sores,  in  herpes,  impetigo,  &c,  settles  the  question  of  its 
sedative  character.] 


8IALAGOGUES.  I  r*r> 

Remote  Effects. — TIioso  vary  considerably  with  the  manner  in  which 
it  is  used,  and  also  with  the  particular  preparation  which  may  be 
selected.  The  differences  between  the  various  preparations  will  be 
mentioned  hereafter.  At  present,  I  shall  only  notice  the  general  effects 
of  this  agent. 

In  small  repeated  alterative  close?,  the  effeet  of  the  mercurials  is  to 
promote  gently  the  secretions,  but  particularly  those  of  the  mucous 
system.  Tin's  they  do  without  causing  any  sensible  evacuations,  and 
without  producing  any  general  disturbance  of  the  system,  provided  their 
vise  be  not  continued  too  long. 

In  larger  doses,  they  act  more  manifestly  upon  the  secretions,  augment- 
ing those  of  the  mucous  membrane,  exciting  the  liver,  and  causing  evacua- 
tions from  the  bowels. 

The  first  symptoms  of  salivation  are  tenderness  and  swelling  of  the 
gums,  which  become  of  a  pale  rose  color,  and  at  the  part  surrounding 
the  teeth  of  a  deep  red.  The  soreness  increasing,  the  tongue  swells,  the 
breath  has  a  peculiar  fector,  and  a  styptic  taste  is  perceived  in  the  mouth. 
The  salivary  glands  now  swell  and  are  tender,  and  there  is  a  profuse 
flow  of  saliva  and  mucus  from  the  mouth.  To  this,  ulceration  of  the 
mouth  often  succeeds,  and  in  severe  cases  the  teeth  are  loose,  and  the 
gums  gangrenous.  The  local  irritation  is  accompanied  with  a  degree  of 
prostration  which  is  sometimes  dangerous  and  has  proved  fatal.  Even 
in  mild  cases,  fat  is  usually  absorbed  pretty  rapidly  and  more  or  less 
emaciation  results. 

Remote  Effects  on  the  Mucous  System. — The  sympathy  of  action 
between  different  portions  of  the  mucous  membrane  is  perhaps  in  no 
instance  so  strikingly  illustrated  as  in  the  operation  of  this  agent.  Its 
impression  gradually  extends  itself  to  all  parts  of  the  system,  until 
sooner  or  later  not  a  ramification  of  this  tissue  in  any  part  of  the  body 
remains  unaffected,  .The  membrane  lining  the  alimentary  canal,  from  the 
mouth  to  the  rectum,  as  well  as  that  lining  the  pulmonary,  the  uterine, 
and  urinary  organs,  are  all  more  or  less  influenced  by  it,  and  the  general 
effect  is  to  produce  an  increase  of  secretion  from  them.  The  evidences 
of  this  fact  are  so  obvious  as  to  require  no  illustration.  In  the  alimen- 
tary canal  we  see  it  in  the  moist  state  of  the  mouth  and  in  the  increased 
evacuations  from  the  bowels. 

0)i  the  Glandular  System. — Here  the  effect  of  mercury  is  still  more 
marked  even  than  it  is  on  the  mucous  system.  It  excites  into  action 
almost  all  the  secretory  glandsrand  increases  in  a  remarkable  manner  the 
quantity  of  secreted  fluids.  The  gland  upon  which  this  is  first  and  espe- 
cially exerted  is  the  liver,  as  is  shown  by  the  change  wrought  in  the 
character  of  the  intestinal  evacuations,  wdiich  frequently  assume  a 
decidedly  bilious  hue,  from  the  operation  of  a  single  dose  of  mercury. 
The  pancreas  is  probably  affected  in  a  similar  way,  although  we  have  not 


166  MATERIA   MEDICA   AND   THERAPEUTICS. 

the  same  striking  evidence  of  the  fact.  On  the  kidneys,  a  like  effect  is 
produced.  The  glands,  however,  on  which  this  effect  is  most  palpably 
exerted  are  the  salivary,  which  under  the  influence  of  this  agent  pour  out 
continued  and  profuse  evacuations. 

[The  most  constant  effect  of  the  free  use  of  mercurials  is  salivation. 
The  first  symptoms  are  slight  tenderness  and  swelling  of  the  gums,  with 
a  pale  rose  color,  and  a  deep  red  at  the  edges  near  the  teeth.  The 
mouth  is  sore;  the  tongue  swollen  ;  a  coppery  taste  is  felt;  the  breath 
has  a  peculiar  fcetor  ;  the  salivary  glands  are  tender  and  swollen.  There 
is  free  flow  of  saliva  and  buccal  mucus,  often  to  the  extent  of  several 
pints  in  twenty-four  hours.  While  these  effects  are  produced,  the  pa- 
tient emaciates  very  rapidly,  fat  being  absorbed.  The  blood  is  com- 
monly buffy.  Salivation  is  now  rarely  pushed  to  the  extent  formerly 
common.  The  old  writers  speak  very  complacently  of  a  flow  of  three 
quarts  as  a  good,  free  discharge.  Now  we  touch  the  gums  and  secure 
all  the  good  effects  of  mercury.  The  saliva  flowing  under  the  irritation 
of  mercury,  differs  from  the  healthy  secretion  in  being  less  viscid,  and 
containing  a  substance  analogous  to  coagulated  albumen,  as  it  exists  in 
the  serum  of  the  blood.  Mercury  seems  to  assimilate  the  saliva  to  the 
exhaled  fluid  of  serous  membranes. 

As  a  sequel  to  salivation  we  often  see  ulceration  of  the  mouth,  fauces, 
and  throat,  with  occasional  gangrene.  The  teeth  are  loose,  bits  of  rot- 
ten gum  or  necrosed  jaw  are  discharged,  and  the  saliva  is  of  the  most 
disgusting  fcetor.  These  local  troubles  are  attended  by  irritative  fever, 
with  rapid  wasting  of  strength,  profuse  sweats,  sleeplessness,  nervous 
tremors,  and  sometimes  fatal  prostration.  All  these  evil  effects  have 
again  and  again  followed  the  use  of  "  a  few  grains  of  calomel,"  a  single 
blue  pill,  or  the  like  so  called  "harmless  dose"  Among  the  less  com- 
mon evil  effects  of  mercury  are  mercurial  tremblings  (tremor  mercurialis) , 
marked  by  unsteadiness  of  the  limbs,  tremors,  vertigo,  stammering,  loss 
of  memory,  and  finally  convulsions,  often  fatal.  Diseases  of  the  skin 
have  followed  the  use  of  mercury  so  often  that  systematic  writers  speak 
of  eczema  mercuriale,  lepra  mercurialis,  erysipelas  mercuriale,  in  the 
progress  of  which  the  epidermis  is  detached,  and  the  hair  and  nails  fall 
off.  Mercury  often  destroys  life,  by  producing  the  cachexia  mercurialis  ; 
the  powers  of  digestion  are  gone,  appetite  lost,  while  a  wasting  diarrhoea, 
often  dependent  on  ulceration  of  the  intestines,  hurries  the  poor  sufferer 
into  the  grave.] 

On  the  Cutaneous  System. — From  the  sympathy  existing  between 
the  mucous  membranes  and  the  skin,  articles  that  make  an  impression 
on  the  one  are  very  apt  to  affect  the  other.  This  is  the  case  with  mer- 
cury. Its  effect  is  transmitted  to  the  cutaneous  structure,  and  exhibits 
itself  sometimes  in  a  simple  increase  of  the  natural  exhalation  from  the 
skin,  and  at  other  times  in  altered  action  of  the  part. 


8IALAG0GUES.  107 

On  the  Nervous  System,  the  effect  of  mercury  is  that  of  an  irritant. 
If  its  use  be  continued  for  nny  length  of  time  it  disturbs  the  equilibrium 

of  the  nervous  system,  and  frequently  causes  excessive  gcHfiia]  irrita- 
bility. 

On  the  Vascular  System,  the  effect  of  tliis  agent  varies  with  the  con- 
dition of  the  system,  and  the  quantity  which  may  be  given.  If  con- 
tinued for  any  length  of  time  it  unquestionably  acts  as  a  stimulant  to 
the  circulation,  and  establishes  throughout  the  system  an  excitement 
peculiar  to  itself. 

On  the  Blood  and  Fluids. — When  a  patient  is  under  the  influence  of 
mercury,  the  blood  assumes  the  same  buffy  coat  which  it  does  in  cases 
of  inflammation,  and  according  to  the  observations  of  some  becomes  of 
a  much  darker  color  than  natural.  The  effects  of  mercury  on  the  blood 
are  to  diminish  the  amount  of  fibrine,  albumen,  and  red  globules  in  it, 
and  to  increase  the  water,  and  perhaps  the  fatty  matters.  Hence  its 
coagulability  is  diminished,  the  clot  is  smaller  and  less  firm. 

On  the  Saliva  it  produces  some  striking  changes.  By  Dr,  Bostock, 
who  analysed  very  carefully  the  saliva  of  a  patient  under  full  mercurial 
influence,  it  was  ascertained  that  the  character  of  it  was  very  much 
altered,  being  changed  from  "the  state  of  a  mucous  to  that  of  a  serous, 
or  rather  an  albuminous  fluid ;"  and  he  supposes  that  the  operation  of 
mercury  upon  these  parts  is  to  counteract  the  ordinary  secreting  pro- 
cess, and  to  reduce  the  action  of  the  glands  to  that  of  mere  transuda- 
tion. He  also  suggests,  that  as  one  operation  of  mercury  is  to  change 
a  mucous  to  a  serous  fluid,  whether  we  may  not  conceive  that  the 
action  of  this  remedy  in  the  cure  of  glandular  obstructions  consists  sim- 
ply in  producing  this  change  of  secretion;  and  whether  even  in  the 
removal  of  the  diseases  of  surfaces,  mercury  may  not  operate  upon  the 
same  principle,  by  counteracting  the  effect  of  specific  secretions,  and 
reducing  them  to  the  mere  transudation  of  a  serous  fluid.  Dr.  Ure 
found  that  ordinary  saliva  contained  a  peculiar  acid,  the  sulpjio-cyanic 
acid,  which  was  not  present  in  the  saliva  which  flows  during  mercurial 
salivation. 

Circumstances  Modifying  these  Effects. — With  the  different  conditions 
in  which  the  human  body  is  found,  the  effects  of  this  agent  vary  very 
considerably.  In  a  practical  point  of  view  these  variations  are  exceed- 
ingly important. 

Age. — It  is  a  fact  supported  by  abundant  observation,  that  children 
can  bear  larger  proportionate  doses  of  calomel  than  adults.  This  may 
be  owing  probably  to  the  intestines  at  this  early  age  being  more  com- 
monly lined  with  mucus,  which  prevents  the  absorption  of  the  mercury. 
Another  fact  equally  well  established  is  that  infants  are  not  so  readily 
salivated  as  adults.  Indeed  in  children  under  two  or  three  years  of  age 
salivation  is  a  very  rare  occurrence.     Maunsell  savs,  "  we  have  never 


168  MATERIA   MEDICA   AXD   THERAPEUTICS. 

succeeded  in  salivating  a  child  under  three  years  old,"  p.  6S.  Dr. 
Rush,  in  speaking-  of  its  use  in  croup,  states  that  "he  never  knew  it 
excite  a  salivation  when  given  to  children  whose  ages  rendered  them 
subjects  of  it."*  Dr.  Warren  of  Boston  says,  "I  have  never  known  an 
infant  to  be  salivated,  notwithstanding  I  have  given  in  some  instances 
large  quantities  with  this  view."f  The  same  appears  to  be  applicable 
to  the  external  use  of  it.  Dr.  Percival  remarks  that  he  "  repeatedly 
observed  that  very  large  quantities  of  th-e  unguentum  ceruleum  may  be 
used  in  infancy  and  childhood,  without  affecting  the  gums,  notwith- 
standing the  predisposition  to  a  flux  of  saliva  at  a  period  of  life  incident 
to  dentition."|  When,  however,  they  do  become  salivated,  as  is  some- 
times the  case,  its  effects  are  most  disastrous.  Sloughing  of  the  gums 
and  cheeks,  general  prostration,  and  death  not  unfrequently  occur.  Dr. 
Blackall  remarks,  "  a  general  opinion  prevails  that  the  constitutions  of 
infants  resist  mercury  in  a  remarkable  degree.  Its  entrance  into  the 
system  they  .certainly  do  resist  more  than  we  could  expect.;  but  they 
are  greatly  overcome  by  salivation ;  and  the  possible  occurrence  of  such 
accidents  may  well  set  us  constantly  on  our  guard."§ 

Sex. — As  a  general  rule,  females  appear  to  be  much  more  readily 
affected  by  mercury  than  males.  On  this  point  a  striking  fact  is 
recorded  by  Mr.  Carmichael.  He  states  that  on  his  first  appointment 
at  the  Lock  Hospital  in  Dublin,  he-made  no  distinction  between  the  quan- 
tity used  whether  for  males  or  females.  He  soon  found,  however,  that 
in  females  this  was  constantly  followed  by  excessive  salivation,  attended 
with  .dysenteric  affections,  extreme  debility,  and  sometimes  dropsy,  while 
in  males  none  of  these  effects  ensued.  On  using  half  the  quantity,  this 
was  obviated,  and  at  the  same  time  the  full  mercurial  effect  obtained. || 

Temperament  and  Constitution. — This  modifies  very  greatly  the  effect 
of  this  agent.  Nervous  and  irritable  habits,  as  a  general  rule,  bear  very 
badly  the  operation  of  this  metal.  Indeed,  if  carried  to  any  extent  in 
them,  it  is  very  apt  to  be  followed  by  effects  exceedingly  distressing  and 
injurious.  Among  these  the  most  common  and  marked  are  restlessness, 
anxiety,  and  a  general  increase  of  constitutional  irritability,  predisposing 
the  system  to  the  invasion  and  development  of  various  diseases.  Mr. 
Travers  states  that  ho  has  "  seen  in  more  than  one  instance,  acute  pneu- 
monia, and  in  another  mania,  set  up  by  the  excitement  of  mercury,  which 
proved  speedily  fatal,  without  any  previous  organic  disease,  or  prohibi- 

*  Obs.  and  Inqs.,  vol.  ii.  p.  379. 

f  View  of  the  Mercurial  Practice  in  Febrile  Diseases.  By  John  "Warren,  M.D., 
p.  146. 

%  Percival's  Essays,  vol.  ii.  p.  318. 

§  Blackall  on  Dropsy,  p.  126. 

||  An  Essay  on  Venereal  Diseases,  &c.  By  Richard  Carmichael,  M.R.I.A., 
p.  307. 


SIALAGOGT/ES.  160 

tory  disposition."*  Tremors  and  paralysis  have  also  been  known  to 
result  from  its  long  continued  use  Dr.  Falconer  of  Bath  says,  "  I  have 
seen  repeatedly  from  this  cause  (the  use  of  mercury)  such  a  shocking 
depression  of  spirits,  and  other  nervous  agitations  with  which  it  was 
accompanied,  as  to  make  it  more  than  merely  probable  that  many  of 
the  suicides  which  disgrace  our  country  were  occasioned  by  the  intolera- 
ble feelings  that  result  from  such  a  state  of  the  nervous  system."f 

Climate  and  Temperature. — Although  warm  climates  and  the  warm 
seasons  of  cold  climates  are  considered  most  propitious  to  the  adminis- 
tration of  mercury,  yet  it  will  be  found  much  more  difficult  to  bring 
the  system  under  its  influence  under  these  circumstances.  It  is  on  this 
account  that  so  much  larger  quantities  are  required  and  used  in  tropical 
regions,  and  the  reason  doubtless  is  the  great  tendency  which  there  is 
to  the  skin,  diverting  its  action  from  other  parts.  Mr.  Ainslie  says,  this 
was  so  commonly  .observed  in  the  East  Indies,  that  he  was  "  in  the 
habit  of  recommending  those  who  could  do  it  with  convenience,  to 
remove  during  the  time  they  were  using  it  .(mercury)  to  some  cold  situ- 
ation.'^ In  the  days  of  Sydenham,  it  was  customary  to  send  syphilitic 
patients  to  the  south  of  France,  as  experience  had  proved  that  large 
quantities  of  mercury  could  in  that  climate  be  introduced  into  the  sys- 
tem without  producing  salivation.§  As  a, general  rule,  it  may  be  laid 
down,  that  a  constant  and  active  determination  to  the  skin  always  inter- 
feres more  or  less  with  the  specific  action  of  mercury  on  the  salivary 
glands.  Hence  it  is  that  Plummer's  pill  is  less  likely  to  salivate  than 
some  of  the  other  preparations  .of  this  metal. 

Independently  of  mere  temperature,  certain  regions  seem  to  be  adverse 
to  the  kindly  operation  of  this  metal  on  the  human  sj'steim  In  Egypt, 
according  to  Baron  Larrey,  the  use  of  it,  even  in  the  venereal  disease, 
requires  the  greatest  caution  ;  if  applied  with  the  same  freedom  as  in 
Europe,  it  produces  fatuity,  hepatic  disorders,  <fec.|| 

Mr.  Fcrgusojp,  Inspector-General  of  Hospitals  in  the  Portuguese  army, 
states,  that  in  the  soldiers  composing  the  British  army  in  Portugal,  vene- 
real ulceration  was  not  only  more  intractable  to  the  operation  of  mer- 
cury than  under  similar  circumstances   at  home,  but  the  constitution, 


*  On  Constitutional  Irritation.     By  Benj.  Travers,  F.R.S.,  &c.,  p.  21  Am.  Ed. 

\  Transactions  of  the  Medical  Society  of  London  for  1809.  Hamilton  on  Mer- 
cury, pp.  14,  15.  Ainslie's  Mat.  Med.,  vol.  i.  p.  643.  Carmichael  on  Yenereal  Dis- 
eases.    Edited  by  G.  Emerson,  M.D.,  p.  302. 

%  "  For  instance,  if  in  the  Carnatic,  that  the  patient  should  proceed  to  the  Mysore 
country,  or  to  the  delightful  and  cool  valley  of  Courtelam,  in  the  Tinnivelly  district." 
— Mai.  Ind.,  vol.  i.  p.  554. 

§  Thomson's  Mat.  Med.,  vol.  i.  p.  396. 

1|  Memoirs  of  Military  Surgery.  Translated  by  R.  "W.  Hall,  M.D.  &  P.,  vol.  L 
p.  144. 


170  MATERIA   MEDICA    AND   THERAPEUTICS. 

while  strongly  under  the  influence  of  the  remedy,  became  affected  with 
secondary  symptoms  in  a  proportion  that  could  not  have  been  expected.* 
Habit. — Unlike  many  other  medicines,  the  system  does  not  become 
habituated  to  the  use  of  mercury,  so  as  to  require  an  increase  of  quan- 
tity to  produce  its  effects.  Mr.  Carmichael  says  on  this  subject,  "  When 
a  patient,  whether  male  or  female,  has  been  salivated  several  times,  and 
the  system,  therefore,  habituated  to  mercury,  it  is  incredible  the  small 
quantity  of  that  mineral  that  is  sometimes  capable  of  exciting  the  severest 
effects."f  Persons,  too,  who  have  gone  through  several  courses  of  mer- 
cury, and  whose  constitutions  are  impaired,  often  suffer  greatly  during  a 
mercurial  course.  Profuse  salivation,  dysentery,  and  great  debility,  are 
frequent  occurrences.  Several  cases  which  have  fallen  under  my  own 
observation  confirm  the  correctness  of  this  opinion. 

6.  Hospital  or  Private  Practice. — Whether  the  mercury  be  adminis- 
tered in  venereal  hospitals  or  in  private  practice  makes  a  great  difference 
in  the  effect.  In  general,  much  smaller  quantities  are  required  to  affect 
the  system  in  an  hospital  than  in  ordinary  practice.  This  may  be  owing 
partly,  to  the  well  regulated  temperature  of  an  hospital,  but  more  espe- 
cially to  the  atmosphere  being  impregnated  with  mercurial  vapor.  Mr. 
Carmichael  states  that  one  or  two  ounces  of  ointment  were  found  suffi- 
cient in  the  Lock  Hospital  of  Dublin,  not  only  to  cure  the  disease,  but 
to  keep  up  an  irritation  in  the  system  for  one  or  two  months.^ 

7.  Actual  state  of  the  System  as  to  Disease.— Of  all  the  modifying 
circumstances  this  is  one  of  the  most  influential.  Certain  diseases  seem 
to  resist  the  mercurial  impression ;  of  these,  mania  is  one.  Very  large 
quantities  of  calomel  have  been  given  to  insane  persons  with  very  slight 
obvious  effects.  Elliotson  gave  nine  ounces  of  calomel  in  six  months  to 
a  young  man,  with  very  moderate  salivation  as  the  only  result. 

Croup. — Here  too  immense  doses  of  calomel  have  been  given  without 
obvious  effects.  On  the  other  hand,  in  scrofula,  moderate  ptyalism  will 
often  produce  the  most  disastrous  consequences. 

[Albuminuria. — This  is  one  of  those  diseases  in  which  there  seems  to 
be  a  special  susceptibility  to  the  evil  influence  of  mercurials.  If  ventured 
on  even  in  small  doses,  it  should  be  with  great  care  and  very  close 
watching.] 

PATHOLOGICAL    EFFECTS    OF    MERCURY. 

Having  spoken  of  the  ordinary  medicinal  or  physiological  effects  of 
mercury,  I  will  devote  a  few  words  to  two  of  the  diseases  which  are 
most  confidently  attributed  to  the  agency  of  mercury. 

*  Medico-Chir.  Trans,  of  London,  vol.  iv.  pp.  1,  2. 

\  Carmichael,  p.  308. 

\  Carmichael  on  the  Venereal  Disease,  p.  116  ;  also  p.  302. 


8IALAGOGUE8.  171 

1.  Erylhysmus  mcrcurialis. — This  was  first  noticed  by  I'ierson  al  the 
Lock  Hospital ;  the  symptoms  arc  depression  of  strength,  a  sen  e  of 
anxiety  about  the  prsecordia,  frequent  Bighing,  trembling,  irregular  action 
of  tlic  heart,  pulse  small,  quick,  and  occasionally  intermitting,  vomiting, 
a  pale  contracted  countenance.  When  these  symptoms  were  present, 
any  exertion,  as  walking  rapidly  across  a  room,  rising  suddenly  from  a 
chair,  lias  instantly  destroyed  life.  The  affection  does  not  at  all  depend 
on  the  quantity  of  mercury  taken,  or  on  the  presence  of  salivation. 

2.  Eczema  mercuriale. — Called  also  erythema  mercuriale,  lepra  mcr- 
curialis,  hydrargyria,  erysipelas  mercuriale.  The  disease  occurs  about 
eight  or  ten  days  after  the  beginning  of  a  mercurial  course;  it  is 
ushered  in  by  heat  and  itching,  first  felt  about  the  scrotum,  thighs,  groin, 
and  bend  of  the  arm.  These  parts  are  rough  and  faintly  red.  Though 
the  disease  spreads  over  the  whole  body,  yet  the  lower  extremities  are 
usually  attacked  before  the  upper;  the  anterior  portion  of  the  body 
before  the  posterior.  There  is  some  swelling  of  the  parts,  frequent  pulse 
and  white  tongue.  The  eruption  is  vesicular,  the  vesicles  very  minute, 
though  in  the  progress  of  the  disease  they  attain  the  size  of  a  pea.  When 
ruptured,  they  are  commonly  followed  by  irritable  excoriations,  from 
which  a  fetid  discharge  follows.  This  continues  but  a  few  days,  when 
the  sores  dry  up,  then  brown  or  black  scales  form  and  fall  off,  leavino-  a 
red  surface.  Sometimes  the  hair  and  nails  fall  off.  The  disease  runs  its 
course  in  from  ten  days  to  as  many  weeks;  it  rarely  proves  fatal.  Like 
the  previous  disease,  it  does  not  seem  to  depend  upon  the  quantity  of 
mercury  given,  nor  is  it  connected  in  any  way  with  salivation.  It  is 
sometimes  caused  by  a  single  small  dose  of  mercury,  and  has  resulted  from 
the  accidental  application  of  a  few  grains  of  red  precipitate  to  the  skin, 
also  from  the  use  of  black  wash. 


STATES  OF  THE  SYSTEM  UNFAVORABLE  TO  THE  USE  OF  MERCURY. 

From  what  has  been  said  of  the  effects  of  mercury,  it  is  evident  that 
it  cannot  be  used  with  advantage,  nor  even  with  safety,  in  all  states  of 
the  system.  This,  though  so  obviously  true,  is  too  often  disregarded  in 
practice ;  it  is  still  too  much  the  habit  to  use  mercury  as  a  specific,  and 
to  introduce  it  into  the  system  without  regard  to  anything  but  the 
quantity  that  can  be  given.  The  mischiefs  resulting  from  such  a  use  of 
mercury  are  incalculable,  and  have  associated  its  history  with  many  a 
tragic  record.  These  errors,  though  not  now  as  common  as  formerly, 
are  not  entirely  eradicated.  WThat  are,  then,  these  states  of  the  system 
in  which  the  constitutional  effect  either  cannot  at  all  be  produced,  or  is 
attended  with  great  danger  ? 

1.  Plethora,  and  great  vascular  excitement.     This  condition  must  be 

~I2~~ 


172  MATERIA   MEDICA    AND    THERAPEUTICS. 

essentially  modified  by  venesection,  or  other  appropriate  means,  if  we 
desire  to  use  mercury  either  effectually  or  safely. 

2.  A  congested  state  of  any  important  organ,  as  the  brain,  attended 
with  an  oppression  of  the  general  system,  torpor,  languor.  Here  vene- 
section, revulsives,  &c,  should  precede  mercury. 

3.  A  debilitated  state  of  the  system,  attended  with  great  nervous  irri- 
tability, is  especially  unfavorable  to  thtfuse  of  mercury^  If  given  "at  all 
freety,  mercurial  fever  or  some  other  pathological  effect  of  the  drug  is 
almost  sure  to  follow. 

4.  A  scrofulous  habit  of  body,  or  the  existence  of  a  marked  predispo- 
sition to  pulmonary  consumption.  This  state  of  things  most  strongly 
contra-indicates  the  use  of  mercury.  If  a  phthisical  patient  is  obliged 
to  go  through  a  mercurial  course,  his  pulmonary  difficulty  is  almost 
always  aggravated.  This  is  seen  very  often  in  venereal  hospitals,  where, 
in  addition  to  the  internal  use  of  the  metal,  the  patient  lives  in  a  mer- 
curial atmosphere. 

■5.  A  scorbutic  habit,  or  a  constitution  broken  down  by  intemperance 
and  other  bad  habits,  forbids  the  use  of  mercury,  except  under  most 
extraordinary  circumstances. 

6.  The  existence  of  a  peculiar  susceptibility  to  the  poisonous  effects 
of  mercury.  This,  as  I  have  said,  probably  depends  on  some  peculiar 
idiosyncrasy,  and  can  only  be  known  to  exist  by  experience ;  but  where 
it  is  known,  the  case  must  be  very  peculiar  to  justify  us  in  rushing  upon 
an  evil  so  great  and  so  certain  as  the  poisonous  effects  of  mercury ;  the 
mischief  thus  done  is  often,  perhaps  generally,  irreparable.  All  these 
remarks  you  will,  of  course,  understand  as  applying  to  the  continued  use 
of  mercury,  with  a  view  to  its  alterative  or  so  called  constitutional 
effects,  and  not  to  its  occasional  use  as  a  purgative.  Nevertheless,  the 
student  and  the  practitioner  ought  by  no  means  to  lose  sight  of  the  facts 
that  such  occasional  use  of  mercury  as  a  purgative,  even  in  moderate 
doses,  is  followed  by  the  poisonous  effects  of  the  drug,  a  fact  which 
surely  ought  to  restrain  us  from  the  habitual  use  of  this  article  as  a 
cathartic. 

Modes  of  Introducing  Mercury. — 1.  By  the  Stomach. — This  is  the 
common  mode,  and  generally  answers  very  well.  Sometimes,  however, 
it  irritates  the  bowels  and  produces  purging  ;  and  when  this  is  the  case, 
it  is  difficult  to  secure  the  constitutional  effects.  This  is  obviated  by 
combining  with  opium.  Sometimes,  however,  this  does  not  answer,  and 
then  other  modes  of  administering  it  are  resorted  to. 

2.  By  Friction. — Rubbing  the  ointment  on  the  surface.  This  was 
the  earliest  mode  of  using  mercury  for  the  cure  of  syphilis.  The  advan- 
tages of  this  are — it  affects  the  system  more  certainly  than  giving  by 
the  mouth,  it  produces  its  effects  in  a  shorter  time,  and  we  avoid  griping 
or  purging. 


SIAI/AGO&tTBS.  17. 'J 

The  objection  to  its  use  in  this  way  is  the  trouble  and  uncleanline 
Rules. — The  part  on  which  it  is  rubbed  should  be  first  well  washed 
with  soap  and  water,  and  then  from  half  a  drachm  to  ;i  drachm  rubbed 
on  l>y  gentle  friction  for  twenty  or  twenty-five  minutes.  This  to  be 
repeated  daily,  and  when  the  patient  is  able  to  do  it,  it  should  be  per- 
formed hy  himself. 

3.  Fumigations. — This  was  a  mole  formerly  practised,  but  not  much 
in  vogue  at  present. 

In  using  this  the  patient  is  first  undressed,  and  then  put  into  a  box 
with  an  opening  at  the  top  for  the  head.  In  the  hottom  of  the  box  is  a 
small  grate  with  a  heated  iron  in  it.  On  this  the  mercurial  preparation 
is  thrown,  and  thus  converted  into  vapor.  This  vapor  surrounds  the 
whole  body,  and  thus  by  direct  application  to  the  skin  produces  its 
effects. 

Various  mercurial  preparations  have  been  used  for  this  purpose.  The 
first  was  cinnabar.  This,  however,  proved  exceedingly  injurious  from 
the  evolution  of  sulphurous  vapor  which  was  apt  to  be  inhaled.  Mr. 
Abernethy  used  a  powder  prepared  by  adding  3  vi.  of  distilled  water  to 
3  ij  of  aq.  ammonia,  and  then  throwing  5  iv.  of  calomel  into  the  liquor, 
and  shaking  it.  On  filtering  and  drying  a  grey  powder  was  left 
This,  he  says,  contains  a  good  deal  of  quicksilver  in  a  metallic  state,  but 
which  becomes  oxidized  on  being  converted  into  vapor.  Dose,  half  an 
ounce  a  day. 

(a.)  This  mode  affects  the  system  more  rapidly  than  any  other  ;  and 
frequently  does  so  when  all  other  means  have  failed.  It  is  useful  when 
the  speedy  operation  of  mercury  is  necessary. 

(b.)  The  objection  to  it  is  that  it  brings  on  ptyalism  before  a  sufficient 
quantity  of  mercury  is  introduced,  and  that  it  causes  sometimes  debility 
and  prostration. 

M.  Ricord,  at  the  Hop.  du  Midi,  makes  very  frequent  use  of  mercu- 
rial fumigation  in  old  syphilitic  cases.  He  uses  cinnabar,  volatilized  in 
a  small  furnace ;  the  fumigations  are  continued  from  a  quarter  to  half 
an  hour. 

4.  Inhalation. — This  mode  was  practised  during  the  cholera  in  this 
city.  This  is  done  by  having  a  tin  vessel  with  a  bar  of  hot  iron  in  it. 
To  this  was  attached  a  flexible  tube,  one  end  of  which  was  in  the  pa- 
tient's mouth.  Ten  grains  of  the  grey  oxide  thrown  every  few  minutes 
on  the  hot  iron  and  inhaled,  it  salivates  in  a  few  hours. 


MODES    OF    JUDGING    WHETHER    THE    SYSTEM    IS    AFFECTED    BY    MERCURY. 

1.  Salivation. — This  is  the  most  certain  test.     Sometimes,  however, 
this  is  produced  by  a  minute  quantity  of  mercury,  and  then  no  test. 


174  MATERIA   MEDICA   AND   THERAPEUTICS. 

2.  The  Character  of  the  Stools, — This  is  of  great  importance  to 
show  the  effect  of  this  agent  on  the  hepatic  and  intestinal  secretions. 
When  the  evacuations  are  of  a  dark  grey  color,  it  is  a  proof  that  the  article 
acts  merely  on  the  intestinal  canal.  When  they  become  yellowish  it 
proves  that  it  has  acted  on  the  liver*  The  green_cglqr •  of  the  stools  which 
is  so  common  when  calomel  has  been  given,  is  owing  not  to  the  calomel 
directly,  but  to  the  intermixture  of  bile  from  the  liver  and  gall  bladder 
with  the  tough  viscid  secretions  of  the  intestines.  When,  therefore, 
these  evacuations  appear,  it  is  a  proof  that  these  organs  have  been  excited 
into  action  and  evacuated.  Now,  in  many  cases  of  diseases  of  children 
this  is  important.  Young  children  we  know  cannot  be  salivated,  and 
this  then  becomes  an  important  indication  as  to  the  extent  and  kind  of 
action  produced.  In  croup  these  are  the  kind  of  evacuations  which 
generally  give  relief. 

3.  The  Abatement  of  the  Disease  for  which  the  Medicine  was  given. — 
Do  not  rely  too  much  upon  any  of  these  tests  of  the  operation  of 
mercury,  but  watch  the  patient,  and  if  the  mercurial  irritation  appear, 
even  in  a  slight  degree,  stop  the  use  of  the  drug.  Especially  is  this 
important  in  children. 

Salivation. — As  this  is  one  of  the  most  curious  and  interesting  of  the 
effects  of  mercury,  it  ought  to  be  specially  studied.  It  has  been  a 
question  much  disputed  whether  it  is  merely  the  evidence  of  the  system 
being  affected,  or  whether  it  is  also  curative.  I  believe  it  is  powerfully 
curative  as  an  irritant  and  depletant. 

There  are  two  points  in  relation  to  salivation  of  practical  impor- 
tance. 

1 .  The  time  required  to  produce  it.  This  varies  greatly  according  to 
the  peculiarity  of  the  constitution,  the  nature  of  the  disease,  and  the 
mode  of  using  the  mercurial.  With  regard  to  constitutional  peculiarity 
there  is  every  difference.  In  some  cases,  the  smallest  quantity  will 
produce  salivation,  and  that  in  a  very  short  time  ;  sometimes  in  the 
course  of  twenty-four  hours.  In  other  cases,  the  exhibition  of  the 
remedy  for  weeks  and  even  months  will  fail  to  produce  this  effect. 

The  state  of  the  system,  too,  as  to  disease,  causes  a  great  deal  of 
difference. 

Then  the  preparation  used  makes  a  difference.  Calomel  and  blue 
pill  salivate  more  readily  than  corrosive  sublimate.  By  combination, 
too,  with  opium,  the  effect  may  be  facilitated. 

2.  Excessive  Salivation. — Salivation  once  excited  is  exceedingly 
uncertain  in  its  effects — sometimes  excessive — producing  ulceration  and 
great  prostration.  Owing,  first,  to  some  constitutions  being  especially 
susceptible  of  its  action  ;  second,  to  its  accumulating  in  the  system 
without  producing  any  manifest  effects,  when  it  suddenly  bursts  forth 
with  great  violence.      Under  these  circumstances  the  patient  usually 


SIALAGOGUES.  175 

suffers  greatly  and  for  a  long  time.    The  treatment  must  bo  both  •  ■ 
Btitutional  and  local. 

Constitutional. — 1st.  Purging.  This  lessens  the  general  irritation, 
and  derives  from  the  mouth,  but  ars  it  increases  debility  it  is  only  to  be 
used  where  the  patient  has  some  strength.  2d.  Opium.  This  relieves 
pain,  allays  irritation,  and  will  sometimes  diminish  the  secretion.  3d. 
Iodine  has  been  used  as  a  sort  of  antidote  to  mercury  ;  its  powers  are 
more  than  doubtful. 

Local. — A  great  variety  of  washes  and  gargles  have  been  used  as 
remedies  for  mercurial  sore  mouth.  Infusions  of  green  tea  and  other 
mild  vegetable  astringents;  the  water  infusion  of  opium,  lime-water 
properly  diluted,  solutions  of  carbonate  soda,  sugar  of  lead,  &c,  &e. 

[Chloride  of  Sodium,  properly  diluted,  is  the  best  wash  I  know.] 


MODES    IN    WHICH    MERCURY    PROVES    CURATIVE. 

These  are  various,  differing  according  to  the  extent  to  whieh  it  is 
carried.  By  acting  simply  as  a  cathartic.  As  has  been  already  inti- 
mated., mercurial  cathartics,  especially  calomel,  operate  in  a  way 
peculiar  to  themselves,  promoting  hepatic  and  intestinal  secretion,  and 
it  is  by  this  peculiar  action  that  it  proves  so  salutary  in  many  cases — 
relieving  hepatic  congestion  and  proving  revulsive  from  other  parts  of 
the  system.  By  its  peculiar  effect  in  promoting  secretions  from  the 
mucous  membrane. 

If  its  use  be  continued  long  enough  to  bring  the  system  fully  under 
its  influence  as  evidenced  by  ptyalism,  it  promotes  the  secretion  of  the 
extreme  vessels  in  every  part  of  the  system.  In  this  way  it  relieves 
unequal  distribution  of  blood  by  the  uniform  and  permaneut  determina- 
tion of  fluids  which  it  keeps  up  to  these  extreme  vessels,  and  produces 
a  general  change  of  action  in  the  secretory  and  absorbing  vessels.  This 
latter  is  wdiat  is  usually  called  the  alterative  effect  of  mercury. 

By  promoting  absorption. 

In  some  cases,  it  proves  curative  by  its  effects  on  the  salivary  glands 
acting  on  the  principle  of  revulsion. 

Lastly,  in  syphilitic  diseases,  it  appears  to  prove  curative  by  some 
specific  agency. 

Modus  Operandi  of  Mercury, — Is  mercury  absorbed? 

This  matter,  though  till  of  late  fiercely  debated,  is  now  settled;  no 
one  doubts  the  absorption  of  this  as  of  other  medicines. 


176  MATERIA    MEDICA    AND    THERAPEUTICS. 


PRACTICAL    APPLICATIONS    OF   MERCURY   IN   THE    TREATMENT  OP  DISEASES. 

There  is  perhaps  no  one  article  of  the  materia  medica  concerning 
whieh  there  has  been  so  much  difference  of  opinion  as  the  use  of  mercury 
in  various  diseases.  By  some  it  is  reprobated  as  an  agent  profoundly 
deleterious  to  the  constitution,,  while  by  others  it  is  looked  upon  as  the 
panacea  for  almost  every  disease.  By  impartial  and  experienced  ob- 
servers both  these  extremes  must  be  viewed  as  equally  erroneous.  That 
the  profuse  and  indiscriminate  use  of  it  which  has  been  too  common 
has  been  productive  of  great  mischief  cannot  be  questioned.  At  the 
same  time  it  is  equally  unquestionable  that  by  its  judicious  use  many 
diseases  are  controlled  and  subdued  which  otherwise  are  wholly  unma- 
nageable. Even  in  these,  however,  it  depends  in  a  great  measure  upon 
the  manner  in  which  it  is  used,  whether  it  proves  salutary  or  otherwise. 
For  the  purpose  of  illustrating  this,  I  shall  notice  its  use  in  some  of  the 
more  important  classes  of  diseases,  and  in  doing  so,  I  shall  endeavor  to 
point  out  the  general  principles  upon  which  it  is  to  be  prescribed. 

Fevers. — The  principles  upon  which  mercury  may  prove  beneficial  in 
this  group  of  diseases  are  very  simple.  There  is  generally  present  in 
fever  a  congested  state  of  the  liver  and  abdominal  viscera,,  in  conse- 
quence of  which  the  secretions  of  these  organs  are  interrupted  and 
sometimes  changed  in  their  character. 

In  fever,  the  whole  of  the  mucous  tissue,  and  especially  the  mucous 
tissue  of  the  alimentary  canal,  becomes  deranged  in  its  secretory  func- 
tions. Irregular  distributions  of  blood  take  place  in  different  parts  of 
the  system,  showing  themselves  sometimes  in  one  organ  and  sometimes 
in  another,  either  in  the  form  of  inflammation  or  of  simple  congestion. 

Now,  these  are  among  the  prominent  conditions  of  the  system  ob- 
served in  fevers,  and  it  is  for  the  correction  of  these  that  mercury  may 
be  rendered  available. 

It  acts  on  the  liver  and  other  abdominal  viscera,  and  promotes  the 
secretions  from  these  organs.  The  evidence  of  this  is  seen  in  the 
altered  condition  of  the  evacuations  from  the  bowels. 

It  acts  on  the  whole  of  the  mucous  tissue  of  the  alimentary  canal, 
and  excites  the  whole  of  the  secretory  apparatus  of  this  tissue. 

If  its  use  be  continued  long  enough  to  bring  the  system  fully  under 
its  influence,  it  promotes  secretion  from  all  the  extreme  vessels  of  every 
part  of  the  system.  In  this  way  it  relieves  unequal  distributions  of 
blood,  by  the  uniform  and  permanent  determination  of  fluids  which  it 
keeps  up  to  these  extreme  vessels.  These  are  the  ways  in  which  mer- 
cury proves  beneficial  in  fevers — by  certain  effects  which  it  produces  on 
the  abdominal  viscera,  and  by  its  general  action  on  the  secretions.  It 
is  by  no  means  necessary  to  carry  its  use  so  far  as  to  produce  all  these 


S1ALAG0GUKS.  177 

effects  in  ever}'  case  of  fever.  In  some  cases,  all  that  is  required  i  to 
obtain  its  effects  on  tlie  abdominal  viscera  him]  the  mucous  tissue; 
while  in  others  no  good  is  done  until  the  whole  system  is  brought 
under  its  influence.  This  will  he  sufficiently  illustrated  by  briefly  no- 
ticing the  different  forms  of  fever. 

Intermittent  Fever. — In  this  form  of  fever  there  is  always  more  or 
less  of  disorder  of  the  bowels,  and  not  (infrequently  of  the  liver.  The 
former  become  torpid  in  their  action  and  deranged  in  their  secretion, 
while  the  latter  is  often  congested,  and,  as  a  consequence,  impeded  in 
its  function  of  secretino;  bile.  Hence  it  is  that  the  discharges  from  the 
bowels  are  scanty  and  unnatural,  and  there  is  a  sense  of  fulness  and 
oppression  in  the  epigastric  region.  That  these  symptoms  should  ari.-e 
is  what  might  naturally  be  expected,  from  what  takes  place  during  the 
paroxysms  of  this  fever.  Thus,  during  the  cold  stage,  the  general  reces- 
sion of  blood  from  the  surface,  and  the  congestion  of  the  large  organs 
and  blood-vessels,  particularly  those  of  the  abdomen,  during  the  hot, 
the  general  reaction  and  febrile  excitement,  all  are  calculated  to  pro- 
duce just  such  disorder  of  the  liver  and  intestines  as  we  find  present  in 
this  disease.  If  the  paroxysms  have  been  frequently  repeated,  the  dis- 
order of  the  abdominal  viscera  will  be  proportionally  aggravated,  and 
become  more  or  less  chronic.  Now,  before  the  disease  can  be  radically 
cured,  this  condition  of  the  abdominal  viscera  must  be  corrected  by  the 
use  of  appropriate  medicines.  Among  these,  cathartics  are  means  most 
valuable,  and  of  them  the  most  efficient  is  calomel,  aided  by  other 
agents  to  carry  oft"  the  secretions  which  it  produces.  When  properly 
given,  and  when  it  produces  its  legitimate  effects,  calomel  excites  the 
action  of  the  torpid  and  congested  liver,  and  promotes  the  secretion  of 
the  mucous  membrane  of  the  intestines  in  a  way  which  no  other  article 
does.  The  best  mode  of  giving  it  to 'promote  these  effects  is  to  admi- 
nister a  large  dose,  say  ten  grains,  and  in  the  course  of  five  or  six  hours 
to  follow  this  with  castor  oil,  to  carry  off  more  completely  the  morbid 
contents  of  the  intestines.  In  many  cases  a  single  dose  will  answer 
every  purpose ;  sometimes,  however,  it  will  require  to  be  repeated. 
Now,  the  object  of  all  this  is  not  to  arrest  the  fever,  but  simply  to  pre- 
pare the  system  and  especially  the  abdominal  organs,  for  the  adminis- 
tration of  tonics.  If  this  course  has  been  pursued,  as  a  general  rule,  it 
will  be  found  that  a  few  doses  of  cinchona  or  quinine  will  readily  arrest 
the  progress  of  the  fever.  On  the  other  hand,  if  this  preliminary  action 
on  the  abdominal  viscera  has  been  neglected,  the  operation  of  tonics 
will  be  always  more  or  less  uncertain. 

In  ordinary  cases,  therefore,  of  intermittent  fever,  the  only  use  that 
it  is  desirable  to  make  of  mercury  is  to  obtain  its  effects  as  a  cathartic 
on  the  liver  and  intestines,  with  the  view  of  preparing  the  system  for 
the  subsequent  action  of  tonics. 


178  MATERIA   MEDICA   AND    THERAPEUTICS. 

In  some  cases,  however,  the  use  of  this  agent  requires  to  be  carried 
further.  When  the  paroxysms  have  been  repeated  for  a  length  of  time, 
and  as  a  consequence  permanent  obstructions  have  taken  place  in  the 
abdominal  viscera,  it  becomes  necessary  to  make  a  more  decided  impres- 
sion on  the- system,  and  even  to  cany  it  to  the  point  of  ptyalism.  For 
this  purpose,  the  blue  pill  may  be  given  at  night,  and  followed  in  the 
morning  by  mild  laxatives,  and  continued  until  the  desired  effect  is  pro- 
duced. 

In  relation  to  the  effects  of  mercury,  when  given  alone  in  this  fever, 
Dr.  Johnson  gives  the  following  interesting  fact.  He  states  that  in  two 
ships  of  war  in  the  East  Indies,  in  consequence  of  the  great  number  of 
intermittents,  the  bark  had  been  entirely  expended,  and  jn  this  dilemma 
their  only  resource  was  mercury;  "and,  though  this  medicine,"  he 
adds,  "  invariably  stopt  the  paroxysms  as  soon  as  the  system  was  affect- 
ed, yet  three  fourths  of  the  patients  treated  on  this  plan  relapsed  as 
soon  as  the  effects  of  the  mercury  had  worn  off,  and  that  after  three, 
and  in  a  few  instances  four  successive  administrations,  so  as  to  excite 
ptyalism."*  [This  story  seems  to  me  to  be  very  discreditable  to  the 
medical  men  concerned.  The  idea  of  being  driven  to  the  use  of  mer- 
cury, and  that  pushed  to  salivation  because  they  had  no  bark,  is  pre- 
posterous.— How  coolly  they  speak  of  three  or  four  salivations !] 

Remittent  and  J3ilious  Fever. — In  these  forms  of  fever,  the  value  and 
efficiency  of  mercury  as  a  general  remedy,  is  established  beyond  all 
doubt.  In  the  East  Indies,  where  they  prevail  to  so  great  an  extent, 
the  concurring  testimony  of  the  most  intelligent  practitioners  unites  in 
pronouncing  mercury  indispensable,  and  in  fevers  of  our  own  country 
it  has  been  found  no  less  so.  Among  the  symptoms  characterizing 
these  forms  of  disease,  there  are.  none  more  striking  than  those  which 
indicate  a  congested  condition  of  the  abdominal  viscera,  and  a  deranged 
state  of  the  stomach  and  intestines.  There  is  always  more  or  less  oppres- 
sion at  the  prsecordia,  sickness,  vomiting,  together  with  costiveness,  and 
a  vitiated  state  of  the  intestinal  secretions.  To  correct  these  there  is  no 
agent  so  valuable  as  mercury.  Having  premised  venesection  more  or 
less  extensive,  calomel  is  to  be  given  in  large  doses,  say  often  or  twenty 
grains,  and  repeated  according  to  circumstances,  for  the  purpose  of  act- 
ing on  the  liver  and  restoring  the  secretion  of  that  organ,  and  also  on 
the  mucous  membrane  of  the  intestinal  canal,  with  the  view  of  separat- 
ing mucous  accumulations  and  changing  the  secretory  action  of  the 
membrane.  While  giving  calomel  in  this  way,  it  will  be  necessary  to 
interpose  occasionally  some  brisk  cathartic  to  carry  off  more  effectually 
the  morbid  secretions  from  the  intestinal  canal,  and  for  this  purpose  cas- 
tor-oil or  a  combination  of  salts  and  senna  are  the  best.     In  this  way, 

*  On  Tropical  Diseases,  vol.  i.  p.  139. 


SIALAGOGUES.  17!) 

not  merely  the  immediate  effects  of  the  mercury  on  the  abdominal 
viscera  are  more  thoroughly  secured,  but  the  eventual  operation  of  this 
agent  on  the  system  at  large  will  be  more  speedily  and  certainly  brought 
about. 

In  true  typhus,  if  mercury  is  to  be  used  at  all,  which  is  very  doubtful, 
it  must  be  with  very  great  caution,  and  early  in  the  disease.  Later,  it  is 
certain  to  do  nothing  but  harm.  As  a  general  summary  of  the  true  prac- 
tice in  fevers,  I  state  that  mercury  in  intermittent  and  remittent  fevers 
is  not  to  be  used  as  a  specific.  You  want  the  effects  of  calomel  on  the 
secretions  of  the  bowels  and  liver,  to  restore  these  to  health,  not  that 
such  restoration  of  the  secretions  will  always  check  the  fever,  but  they 
prepare  the  system  for  other  remedies.  Now,  this  effect  of  mercury  on 
the  secretions  may  very  often  be  produced  by  one  purgative  dose  of 
calomel  ;  in  other  cases,  more  protracted,  or  originally  more  severe, 
several  purgative  doses  may  be  necessary.  In  a  few  cases  we  may,  by 
the  severity  of  the  congestive  affections,  be  obliged  to  go  so  far  as  to  get 
the  constitutional  effects  of  mercury ;  but  remember  in  all  these  cases, 
it  is  not  to  be  used  as  a  specific,  but  to  prepare  the  way  for  tonics. 

Inflammation. — There  is  no  class  of  diseases  on  which  the  efficacy  of 
mercury  is  more  triumphantly  shown  than  in  inflammations.  This  is,  as 
I  have  before  stated,  an  American  practice.  In  these  cases,  we  use  it 
with  a  view  to  its  general  alterative  effect;  and  when  the  system  is  put 
fully  under  its  influence,  it  exercises  a  wonderful  power  in  arresting  the 
progress  of  inflammatory  action.  In  consequence  of  this,  it  is  called  an 
anti-inflammatory  ageut.  A  beautiful  illustration  of  this  is-afforded  in 
iritis. 

How  mercury  does  this  we  cannot  exactly  say,  probably  by  some 
change  in  the  blood.  The  fact  however  we  know ;  it  is  the  result  of 
observation.  Calomel  is  the  preparation  commonly  used,  and  we  repeat 
it  until  the  system  is  affected.  It  is,  however,  not  equally  useful  in  all 
inflammations;  in  some,  indeed,  it  is  injurious,  especially  in  scrofulous 
habits. 

Tonsiiitis. — In  ordinary  inflammation  of  the  tonsils,  calomel  may  be 
used  with  great  advantage.  After  suitable  depletion  it  should  be  given 
in  a  large  dose,  say  ten  grains,  and  followed  after  an  interval  of  five  or 
•six  hours  by  castor  oil  or  some  other  mild  laxative.  In  this  way,  it 
operates  beneficially,  in  two  modes  : — first,  by  creating  a  new  action  in 
the  liver  and  mucous  membrane  of  the  alimentary  canal,  upon  the 
principle  of  revulsion  ;  and  second,  by  the  peculiar  effect  which  it  has  in 
%  restoring  the  secretion  of  the  mucous  membrane  of  the  part  inflamed. 
In  consequence  of  this  latter  effect,  it  will  not  unfrequently  be  observed 
that  a  single  dose  of  calomel  will  produce  a  complete  change  in  the 
character  of  the  fauces,  causing  a  moist  state  of  the  inflamed  parts,  and 
lessenino-  the  redness  and  tumor. 


ISO  MATERIA    MEDICA   AND    THERAPEUTICS. 

Laryngitis. — This  disease  may  be  either  acute  or  chronic,  and  in  both 
calomel  is  an  agent  of  great  value.  To  be  really  useful,  however,  it 
should  be  carried  to  salivation.  When  this  effect  is  produced,  the  case 
generally  terminates  favorably,  and  it  operates  no  doubt  in  a  great 
measure  by  the  free  secretions  which  it  produces  from  the  mouth  and 
fauces  as  w^ell  as  by  the  counter  irritations  which  it  occasions  in  the 
gums.  In  the  acute  form,  from  the  great  rapidity  with  which  the  disease 
runs  its  career,  the  great  difficulty  is  to  gain  sufficient  time  to  produce 
the  proper  mercurial  effect  on  the  system.  In  cases  of  this  kind,  there" 
fore,  after  the  depletion,  it  is  to  be  introduced  as  speedily  as  possible  and 
in  as  large  doses  as  the  system  will  bear.  In  the  chronic  form,  abun- 
dance of  time  is  allowed  for  its  more  gradual  introduction.  The  utility 
of  calomel  in  both  these  forms  is  established  by  unquestionable  experience. 

In  inflammation  of  the  glottis  arising  from  the  inhalation  of  steam, 
calomel  has  proved  eminently  successful.  Several  interesting  cases  of 
this  kind  are  related  by  Dr.  Wallace,  which  were  treated  by  giving  to  a 
child  two  grains  of  calomel  every  half  hour  or  hour. 

Trachitis. — There  is  no  form  of  inflammation  in  which  mercury  has 
been  more  celebrated  than  in  this.  Who  first  suggested  it  cannot  be 
determined  with  any  degree  of  certainty.  It  is,  however,  unquestionably 
an  American  practice,  and  was  in  extensive  use  in  this  country  during 
the  last  century.  With  regard  to  the  operation  of  this  agent  in  the 
disease,  it  appears  to  be  well  established  that  no  great  relief  is  afforded 
by  it  until  evacuations  of  a  peculiar  character  are  produced.  These 
evacuations  are  of  a  dark  green  color,  resembling  in  their  general 
appearance  boiled  spinach,  and  they  are,  as  before  stated,  combinations 
of  bile  and  mucus.  To  produce  these,  calomel  must  be  given  in  large 
and  repeated  doses ;  from  3  to  5  grs.  at  a  dose,  repeated  every  two, 
three,  or  four  hours.  Frequently  it  is  only  after  the  exhibition  of  30  or 
even  50,  and  in  some  cases  100  grs.,  in  this  way,  that  such  discharges 
are  obtained.  They  are  always  followed  by  a  manifest  amelioration  of 
the  disease,  and  from  the  difficulty  of  producing  salivation  in  young  sub- 
jects, fortunately  this  result  very  rarely  follows  the  use  of  such  large 
quantities  of  this  article.  Of  the  manner  in  which  calomel  accomplishes 
its  purposes  in  this  disease  I  have  already  spoken  under  the  head  of 
cathartics. 

Bronchitis. — In  this  variety  of  inflammation,  whether  acute  or  chronic, 
calomel  frequently  proves  exceedingly  beneficial.  In  the  former  it  may 
be  used  at  first  as  a  cathartic,  and  after  this  with  a  view  to  its  alterative 
effects.  In  the  latter,  i.  e.  the  chronic  form,  it  is  of  more  doubtful  effi- 
cacy. By  judicious  combination,  however,  with  opium  and  antimony  it" 
may  be  used  sometimes  with  great  effect  as  an  alterative — changing 
gradually  the  condition  of  the  mucous  membrane  of  the  bronchi  and 
eventually  effecting  a  cure. 


SIALAGOGUES.  181 

Dysentery. —  Fn  this  disease  mercury  is  a  remedy  of  inestimable  value. 
Associated  witli  inflammation  of  the  intestines,  there  i  generally  a  dis- 
ordered condition  of  the  liver,  as  is  shown  in  the  absence  of  bile.  In 
the  treatment  one  of  the  great  objects  is  to  restore  the  healthy  secretion 
of  the  liver,  and  nothing  does  this  so  effectually  as  eah.mel.  Besides 
this,  it  acts  peculiarly  on  the  mucous  membrane  of  the  intestine  itself, 
lessening  the  inflammation,  and  promoting  secretion.  In  addition  to  all 
this,  if  carried  so  far  as  to  affect  the  gums,  it  acts  still  more  powerfully 
in  the  progress  of  disease.  With  regard  to  the  modi;  of  using  calomel 
in  this  complaint,  there  is  considerable  difference  of  practice.  By  some 
very  large  doses  arc  used,  while  by  others  small  ones  are  preferred.  The 
mode  I  prefer  is,  after  suitable  depletion,  to  give  one  or  two  large  d< 
of  10  or  20  grs.  at  first  to  obtain,  if  possible,  a  decided  cathartic  effect, 
and  after  this  to  trust  to  smaller  and  repeated  closes  for  the  purpose  of 
producing  its  alterative  effects  on  the  system.  Should  the  gums  become 
touched,  the  patient  may  generally  be  considered  free  from  danger. 

Pleurisy  and  Pneumonia. — The  great  remedy  here  of  course  is  vene- 
section carried  to  the  extent  of  producing  a  decided  impression  at  once 
on  the  system.  After  this,  to  subdue  whatever  inflammatory  action  may 
still  remain  as  well  as  to  counteract  the  consequences  of  inflammation  in 
the  way  of  effusion,  there  is  no  remedy  so  effectual  as  calomel  with  the 
view  of  affecting  the  mouth.  In  those  cases  in  which  venesection, 
although  carried  as  far  as  can  be  justified  by  the  strength  of  the  consti- 
tution, does  not  subdue  the  disease,  calomel  is  the  only  remedy  which 
can  be  depended  upon. 

Pericarditis. — The  first  and  great  remedy  in  this  disease  is  venesection, 
with  the  view  of  impairing  the  action  of  the  heart. 

This,  together  with  other  antiphlogistic  means,  such  as  cathartics,  anti- 
monials,  etc.,  may  do  much  in  mitigating  the  violence  of  the  disease. 
Alone,  however,  they  are  not  always  adequate  to  effect  a  cure.  They 
may  arrest  the  inflammation,  but  they  cannot  prevent  some  of  the  con- 
sequences of  it.  Effusion  may  have  taken  place,  and  to  produce  absorp- 
tion the  agency  of  mercury  is  required.  To  obtain  all  its  salutary 
effects  it  must  be  carried  to  the  extent  of  affecting  the  gums,  and  this 
ought  to  be  done  as  speedily  as  possible.  For  this  purpose  calomel  is 
to  be  administered  in  doses  of  five  or  six  grains  three  times  a  day,  com- 
bined, if  necessary  to  prevent  purging,  with  suitable  proportions  of 
opium.  [To  get  the  patient  promptly  under  the  influence  of  mercury,  a 
thing  essential  to  his  entire  recovery,  inunction  may  be  used  while  the 
calomel  is  given  freely.]  To  obtain  the  full  effect  too,  it  is  desirable  to 
keep  the  gums  sore  for  some  days. 

Hepatitis. — There  is  no  form  of  inflammation  in  which  the  peculiar 
powers  of  mercury  are  more  strikingly  illustrated  than  in  this  disease. 
After  due  depletion  it  is  to  be  resorted  to  with  the  double  view  of  pro- 


182  MATERIA    MEDICA    AND   THERAPEUTICS. 

moting  secretion  from  the  liver  and  eventually  producing  its  general 
effects  on  the  system  as  indicated  by  salivation.  In  habits  broken  down 
by  intemperance,  where  depletion  cannot  be  carried  safely  to  any  great 
extent,  as  well  as  in  persons  advanced  in  years,  it  is  the  only  remedy  to 
which  the  safety  of  the  patient  can  be  trusted,  and  in  these  cases  it 
sometimes  operates  with  wonderful  efficacy. 

Rheumatism. — In  this  disease,  both  acute  and  chronic,  the  use  of 
mercury  has  been  greatly  lauded,  but  it  is  to  be  feared  too  indiscrimi- 
nately. In  the  acute  form,  as  a  general  rule,  calomel  should  be  used 
only  as  a  cathartic.  In  this  way,  aided  by  other  cathartics,  it  proves 
exceedingly  useful.  Carried  however  so  far  as  to  produce  salivation, 
little  or  no  good  is  to  be  expected  from  it.  Mackintosh  says,  "  I  have 
often  seen  the  tongues  of  patients  swollen  and  ulcerated  and  profuse 
salivation  induced  without  the  least  signs  of  amendment.1'* 

In  chronic  rheumatism,  an  alterative  mercurial  course,  so  as  to  touch 
the  mouth,  in  some  cases  proves  useful,  although  as  a  general  remedy  it 
is  not  to  be  depended  upon.  When  it  has  any  connection  with  syphilis, 
mercury  becomes  essential.  There  is  another  form  of  chronic  rheumatism 
in  which  a  mercurial  course  is  of  great  service,  and  that  is  when  it  arises 
from  imprudent  exposure  to  cold  during  the  use  of  mercury. 

This  was  originally  noticed  by  Dr.  Bradley,  in  1806,  who  states  that 
he  met  with  several  cases  of  rheumatism  which  attacked  persons  while 
under  the  influence  of  mercury,  for  the  cure  of  complaints  totally 
unconnected  with  syphilis.  In  these  cases,  all  the  ordinary  remedies 
failed,  and  they  were  only  cured  by  having  recourse  again  to  mercury 
till  the  mouth  became  affected,  and  as  soon  as  this  took  place,  the  com- 
plaint yielded.f  Dr.  Scudamore  confirms  this  observation  and  he  says, 
"I  have,  in  every  case  of  this  kind,  seen  that  all  the  ordinary  methods 
of  treatment  are  of  no  avail,  or  afford  only  palliative  and  very  tempo- 
rary relief;  but  I  have  invariably  had  the  satisfaction  of  witnessing 
the  cure  to  be  effected  by  resuming  a  well  conducted  mercurial  course."^ 

In  Gout  the  utility  of  mercury  depends  entirely  upon  the  mode  in 
which  it  is  used.  If  given  simply  as  a  cathartic,  or  in  moderate  quanti- 
ties to  produce  an  alterative  effect  on  the  secretions  of  the  liver  and 
intestines,  it  proves  of  great  advantage.  When  carried  so  far  as  to  excite 
mercurial  fever  or  to  salivate,  it  invariably  does  harm  by  increasing  the 
general  irritability  of  the  system,  prostrating  the  patient's  strength,  and 
even  increasing  or  bringing  back  the  gouty  paroxysms.  Several  cases  of 
this  kind  are  related  by  Scudamore. 

Iritis. — In  this  form  of  inflammation  the  use  of  mercury  is  essential, 

*  Practice  of  Physic,  vol.  ii.  p.  420. 

f  Med.  Reports,  &c.  by  S.  A.  Badsley,  M.D.,  p.  43.     Lond.  1807. 
\  P.  103.     He  also  thinks  that  gouty  habits  are  more  easily  aflected  by  mercury, 
p.  103. 


8IALAG0GTJES,  ',  \2 

and  there  is  no  affection  in  which  its  efficacy  in  more  beautifully  illus- 
trated. Along  with  suitable  depletion,  it.  is  the  only  remedy  on  which 
we  can  depend  for  arresting  the  progress  of  inflammation  as  well  as  re- 
moving its  effects.  In  the  first  place  it  prevents  the  effusion  of  coagu. 
lable  lymph  from  the  iris,  and  in  the  second  place  it,  promotes  absorp- 
tion, if  there  is  effusion.  No  great  benefit,  however,  is  derived  from  it 
until  the  mouth  becomes  sore,  and  it  is  astonishing  how  speedily  after 
this  a  change  takes  place  in  the  appearance  of  the  eve.  To  have  the 
full  benefit  of  it  the  soreness  of  the  mouth  should  be  kept  up  for  some 
time.  In  cases  where  the  constitution  is  sound  and  vigorous  calomel 
may  be  introduced  in  considerable  doses  with  the  view  of  affecting  the 
gums  as  speedily  as  possible.  When,  on  the  other  hand,  the  habit 
is  broken  down  or  scrofulous,  it  must  be  exhibited  in  smaller  quantities 
and  gradually.  In  all  cases  it  should  be  combined  with  suitable  pro- 
portions of  opium. 

Ophthalmia. — Besides  iritis  there  arc. several  other  inflammations  of 
the  eye  in  which  mercury  is  a  valuable  remedy.  In  the  'purulent  or 
Egyptian  ophthalmia,  in  sclerotitis  (or  the  rheumatic  ophthalmia  of 
Mackcnsie),  and  the  catarrh  o-rheumatic  ophthalmia,  the  use  of  calomel 
and  opium  carried  to  the  extent  of  affecting  the  mouth  is  attended  with 
the  happiest  effects. 

Apoplexy. — In  this  disease  mercury,  as  a  general  rule,  can  be  of  no 
further  use  than  as  an  active  and  efficient  cathartic,  and  with  this  view 
it  may  be  used  with  great  advantage  with  other  cathartics  of  a  more 
irritating  and  drastic  character.  On  this  subject  I  have  already  spoken 
under  the  head  of  cathartics. 

Paralysis. — As  a  cathartic  calomel  may  be  used  with  great  advantage 
in  cases  of  paralysis.  By  Dr.  Colles  of  Dublin,  the  use  of  it  has  recently 
been  carried  much  further.  By  him  several  interesting  cases  are  related 
in  which  a  complete  cure  was  effected  by  producing  salivation.  The 
result  of  these  cases  would  certainly  tend  to  show  that  it  is  a  remedy  of 
great  value.* 

Epilepsy. — In  this  disease  mercury  has  been  extensively  used  and 
with  various  results.  In  some  cases  it  has  proved  successful,  while  in 
others  it  has  failed.  Of  its  beneficial  effects  when  used  as  a  cathartic 
there  can  be  no  question.  In  several  cases  which  have  fallen  under 
my  care,  occasional  doses  of  calomel,  aided  by  other  active  cathartics, 
have  proved  of  eminent  advantage.  Of  its  effects  when  carried  so  far 
as  to  cause  salivation  I  have  no  experience  in  this  disease.  Bv  some, 
however,  it  is  spoken  of  in  the  highest  terms.f 


*  Practical  Observations  on  the  Venereal  Disease  and  the  Use  of  Mercury.     By- 
Abraham  Colles,  M.D.,  p.  197.     Am.  Ed. 
f  See  Cook  on  Nervous  Diseases,  p.  401. 


184  MATERIA    MEDICA    AXD   THERAPEUTICS. 

Mania  and  Hypochondriasis. — As  a  cathartic,  in  both  these  affec- 
tions, there  can  be  no  question  as  to  the  utility  of  calomel.  In  Hypo- 
chondriasis more  especially,  associated  as  that  disease  frequently  is  with 
obstructions  of  the  abdominal  viscera,  it  is  particularly  beneficial.  In 
some  cases,  .too,  carried  to  the  extent  of  salivation,  it  has  had  the  happy 
effect  of  completely  restoring  the  patient.  In  these  it  operates,  no  doubt, 
by  removing  local  obstructions,  equalizing  the  circulation  as  well  as  the 
nervous  excitement,  and  probably  too  as  a  counter-irritant,  by  the  irrita- 
tion which  it  produces  in  the  mouth. 

Dropsy. — There  is  no  class  of  diseases  in  which  mercury  in  some 
shape  or  other  has  been  more  generally  used  than  in  the  various  species 
of  dropsy.  The  general  principle  upon  which  it  has  been  prescribed  is, 
that  it  promotes  the  absorption  of  the  effused  fluid,  and  it  has  accord- 
ingly been  given  indiscriminately  to  accomplish  this  object.  To  any 
one  at  all  acquainted  with  the  real  nature  of  dropsical  affections,  it 
must  be  evident  that  this  is  a  very  empirical  mode  of  using  this  potent 
remedy.  Dropsy,  as  I  have  already  told  j7ou,  is  not  so  much  a  disease 
in  itself  as  it  is  the  consequence  of  other  diseased  conditions  of  the  sys- 
tem. Accordingly,  you  will  find  it  sometimes  resulting  from  and  asso- 
ciated with  diseases  of  the  liver,  the  heart,  or  the  kidneys.  Generally 
the  result  of  inflammatory  action,  it  sometimes  is  a  consequence  of  sim- 
ple obstruction  in  the  circulation,  and  sometimes  of  mere  debility. 

From  this  plain  statement,  it  must  be  evident  that  so  potent  a  remedy 
as  mercury  cannot  be  applicable  in  every  form  of  it,  and  extensive  expe- 
rience has  satisfactorily  established  this  fact.  In  many  cases  it  acts  with 
decided  and  astonishing  efficacy,  while  in  others  it  proves  injurious. 

The  kinds  of  dropsical  affections  in  which  mercury  is  most  useful  are 
those  which  are  connected  with  inflammation  or  some  hepatic  disorder. 
Even  here,  however,  the  use  of  it  must  be  confined  within  certain  limits. 
When  the  liver  becomes  indurated,  mercury,  so  far  from  doing  good, 
does  harm,  and  hastens  on  a  fatal  result. 

In  those  cases  in  which  it  is  connected  with  diseased  kidneys,  it  has 
not  been  found  a  salutary  remedy  :  in  these  cases  the  urine  will  generally 
be  found  coagulable  by  heat. 

There  is  no  form  of  dropsy  in  which  mercury  has  been  more  freely 
used  than  in  hydrocephalus.  With  regard  to  the  effect  of  it,  experience 
differs ;  while  some  speak  highly  of  it,  by  others  it  is  looked  upon  as  a 
doubtful  remedy.  Now,  with  regard  to  this  disease,  it  is  to  be  recollected 
that  in  its  primary  shape  it  is  an  inflammation,  while  the  effusion  is  a 
mere  consequence  of  the  inflammation.  Now,  mercury,  if  used  in  the 
first  stage,  in  conjunction  with  bloodletting  and  other  remedies,  may 
prove  exceedingly  advantageous.  As  to  its  efficiency  in  promoting 
absorption  after  effusion  has  taken  place,  I  am  somewhat  skeptical. 
With  regard  to  the  cases   which  have  been  reported  as  having  been 


8IALAOOGUE8.  I    5 

cured  by  calomel,  it  is  to  be  recollected  that  symptoms  very  analogous 
to  those  which  characterize  hydrocephalus  may  exist  vvithoul  there  being 
any  actual  effusion.  Every  now  and  then  we  meet  with  cases  of  this 
kind.  The  inflammation  of  the  brain  may  terminate  in  simple  disten- 
sion of  its  vessels,  producing  symptoms  like  those  of  effusion  ;  then,  again, 
the  same  may  occur  from  a  congested  state  of  the  liver  and  abdominal 
viscera;  also  from  exhaustion. 

Now,  from  all  these,  a  child  may  recover  by  appropriate  treatment.; 
and  these  are  the  cases  which  may  be  reported  as  cases  of  hydrocephalus 
with  effusion. 

In  the  cases  depending  upon  hepatic  congestion,  calomel  may  and 
does  prove  exceedingly  salutary  in  relieving  the  secondary  symptoms 
of  cerebral  oppression. 

As  a  general  rule,  in  using  mercury  in  dropsical  affections,  there 
ought  to  be  some  vigor  of  constitution.  In  old  and  debilitated  subjects, 
it  is  a  remedy  which  requires  very  great  caution. 

In  Chronic  Affections  of  the  Viscera,  arising  from  ordinary  inflam- 
mation as  of  the  liver,  lungs,  <fec,  and  in  congestion  of  these  organs, 
mercury  is  frequently  of  great  advantage.  But  here,  too,  caution  is 
necessary,  and  the  general  state  of  the  system  as  to  vigor  and  power  of 
enduring  irritation  must  be  looked  to. 

[I  feel  it  my  duty  to  say,  in  all  plainness,  that  Dr.  Beck's  estimate 
of  the  value  of  mercury,  in  very  many  of  the  diseases  above  noted,  is 
very  much  higher  than  the  present  state  of  opinion  among  good  prac- 
titioners would  sanction.  Mercury  is  less  and  less  used  as  we  come  to 
understand  the  natural  history  of  disease  better,  and  salivation,  except 
for  venereal  disease,  is  rarely  resorted  to.  The  repeated  and  long-con- 
tinued salivations  of  the  olden  time  are  entirely  out  of  date. — Ed.] 

Venereal  Disease. — On  this  I  have  only  a  single  remark  or  two  to 
make.  By  some  the  use  of  mercury  is  opposed  on  the  ground  that  this 
disease  can  be  cured  without  it ;  and  it  is  true  that  a  vast  deal  of  expe- 
rience has  been  brought  forward  to  show  that  this  is  the  case.  Still,  I 
am  in  favor  of  the  use  of  mercury.  The  result  of  ray  experience  is,  that 
primary  symptoms  heal  readily  without  mercury,  but  the  system  is  more 
liable  to  secondary  symptoms.  When  this  practice  was  first  introduced 
I  tried  it,  and  generally  had  reason  to  regret  it. 


PREPARATIONS    OF    MERCURY. 

In  the  State  of  Metal. — Native  State. — This  metal  is  sometimes 
found  in  a  pure  state,  when  it  is  called  virgin  mercury :  sometimes  in 
the  state  of  protochloride,  when  it  is  called  horn  mercury ;  usually,  how- 
ever, it  is  in  combination  with  sulphur,  forming  the  native  cinnabar.     It 


186  MATERIA    MEDICA    AND    THERAPEUTICS. 

is  found  in  various  parts  of  the  world.  Its  principal  localities  are  the 
Idria  mines  in  Austria,  Almaden  in  Spain,  Mexico,  and  Peru. 

Mode  of  Extraction. — Almost  all  the  mercury  which  is  used  is  ob- 
tained from  the  sulphuret.  The  ordinary  mode  resorted  to  for  separat- 
ing the  quicksilver  is  to  mix  the  ore  with  lime  and  subject  to  the  action 
of  heat  in"  iron  retorts,  with  receivers  attached  to  them.  During  this 
process  the  sulphur  unites  with  the  lime,  forming  sulphuret  of  calcium 
and  sulphate  of  lime;  while  the  quicksilver  is  distilled  over  and  con- 
densed in  the  receivers.  It  is  then  put  into  iron  flasks,  containing  sixty 
or  seventy  pounds,  covered  with  goat's  skin.     It  is  in  this  state  exported. 

Properties. — At  ordinary  temperatures  mercury  is  fluid,  of  a  silver 
white  color,  metallic  lustre,  destitute  of  smell  and  taste ;  its  specific 
gravity  is  13'5.  It  freezes  at  — 39°,  and  becomes  solid  and  malleable. 
It  boils  at  656°,  and  is  totally  dissipated  by  heat. 

Tests  of  its  Purity. — Entirely  sublimed  by  heat, — when  a  globule  is 
m6ved  along  a  sheet  of  paper,  it  leaves  no  trail. 

Impurities  and  Adulterations. — As  generally  found  in  commerce, 
quicksilver  is  tolerably  pure.  Sometimes,  however,  it  contains  impuri- 
ties, and  the  articles  associated  with  it  generally  are  lead,  tin,  and  bis- 
muth. In  this  state  it  loses  its  metallic  brilliancy,  and  has  a  dull,  dirty 
appearance.  It  is  also  less  fluid  and  mobile,  and  when  shaken  in  a  vial 
soils  the  glass.  The  mode  of  purifying  it  is  to  mix  it  with  iron  filings^ 
and  then  distil  it  in  iron  retorts. 

Physiological  Effects. — Taken  in  its  ordinary  metallic  state,  mercury 
is  generally  supposed  not  to  exert  any  action  on  the  human  system,  and, 
accordingly,  in  the  present  day  it  is  not  used  as  a  medicinal  agent.  In 
a  state  of  extremely  minute  division,  metallic  mercury  is  by  some  sup- 
posed to  have  the  power  of  acting  on  the  system.  This  it  certainly  does 
when  in  the  state  of  vapor,  and  it  is  now  the  prevailing  opinion  that  in 
the  blue  pill,  blue  ointment,  and  kindred  preparations,  mercury  exists 
chiefly,  if  not  exclusively,  in  the  state  of  extremely  minute  divisions. 
See  on  those  articles.  Formerly,  metallic  mercury  was  frequently  used 
with  a  view  of  obtaining  its  mechanical  effects,  in  cases  of  intestinal  ob- 
structions. Ounces  and  even  pounds  were  thus  given  to  force  a  way 
throuo-h  the  bowels  by  means  of  its  specific  gravity.  In  these  cases  none 
of  the  ordinary  effects  of  the  mercurial  preparations  were  produced.* 
In  its  fluid  form  mercury  produces,  then,  little  or  no  effect,  yet  it  is 
important  to  recollect  that  in  the  state  of  vapor  it  does  affect  the 
system,  and  that  it  passes  into  this  state  at  the  ordinary  temperature 
of  the  atmosphere.  A  striking  instance  of  this  occurred  in  the  year 
1810  in  a  couple  of  English  ships  which  had  on  board  a  large  quantity 
of  quicksilver.     On  the  voyage  some  of  the  flasks  burst  and  the  quick- 

*  On  this  subject  see  Christison  on  Poisons,  p.  316,  Diet.  Mat.  Med.,  voL  iv.  p. 
336. 


SIAXAGOGrtJES.  18T 

silver  was  spilled.    Shortly  after,  all  the  men  became  salivated  and  two 

of  tli cm  died.* 

Pilule  1  IvDiiAitd vur. — This  is  known  by  the  common  name  of  the 
Blue  Pill.  It  is  prepared  by  the  long  trituration  of  purified  quick- 
silver (  3  j)  with  confection  of  red  roses  (  3  >ss)  and  pulverized  liquorice 
root  (  §  ss).f  In  this  way  a  soft  bine  mass  is  formed.  For  the  purpo  e 
of  ascertaining  whether  the  mercury  has  undergone  the  necessary 
trituration,  or  as  it  is  usually  called  is  "  killed,"  a  small  portion  of  the 
mass  may  be  rubbed  with  the  end  of  the  finger  on  a  piece  of  glass  or 
paper.  If  no  globules  are  perceptible,  it  is  an  evidence  of  it-,  being 
sufficient.  As  the  manufacture  of  this  pill  requires  a  good  deal  of  time 
and  labor,  it  is  very  apt  to  be  imperfectly  prepared.  At  Apothecaries' 
Hall  in  London,  where  the  article  is  made;  in  the  greatest  perfection, 
the  trituration  is  effected  by  means  of  "  a  machine  impelled  by  a  steam 
engine,  consisting  of  a  circular  iron  trough  for  the  reception  of  the 
materials,  in  which  revolve  four  wooden  cylinders,  having  also  a  motion 
on  their  axis;  in  this  way  the  admixture  of  the  mercury  is  perfectly 
and  unexceptionably  effected.''^  With  regard  to  the  precise  state  in 
which  the  mercury  exists  in  the  preparation,  there  is  some  difference 
of  opinion.  By  some  it  is  supposed  to  be  simply  in  a  state  of 
minute  division,  while  by  others  it  is  thought  to  be  converted  into 
an  oxide. 

[There  is  now  no  doubt  among  the  best  informed  pharmaceutists 
that  the  greater  part  of  the  mercury  in  this  and  the  analogous  prepara- 
tions is  in  a  state  of  mere  mechanical  division — the  only  dispute  is 
whether  any  of  it  is  oxidized.  If  there  is  any  oxide  in  the  preparation, 
the  proportion  is  certainly  very  small. — Ed.] 

Three  grains  of  the  blue  mass  contain  one  of  mercury. 

Impurities  and  Adulterations. — The  only  important  impurity  to 
which  the  blue  mass  is  liable  arises  from  the  accidental  presence  of 
sulphuric  acid  in  the  confection  of  roses.  This  acid  is  sometimes  added 
to  heighten  the  color  of  the  confection,  and  in  this  way  a  sulphate  of 
mercury  may  be  formed  during  the  trituration,  and  thus  the  preparation 
be  rendered  not  merely  uncertain  but  irritating. 

Effects. — This  is  a  mild  and  exceedingly  valuable  preparation  of 
mercury.  Like  the  others,  its  effects  differ  with  the  dose.  In  small 
doses  it  gently  stimulates  the  liver  and  increases  the  secretion  of  bile ; 
at  the  same  time  it  promotes  the  secretions  of  the  mucous  membrane 
of  the  digestive  organs  generally.  In  this  way  it  produces  the  effects  of 
a  general  mercurial  alterative.     If  its  use  be  continued  sufficiently  long 

*  Edin.  Med.  and  Phys.  Jour.,  vol.  vi.  p.  513. 

•J-  The  liquorice  root  is  added  to  give  consistence  to  the  mass. 

%  Brande's  Manual,  p.  500. 

13 


188  MATERIA   MEDICA   AND   THERAPEUTICS. 

it  produces  all  the  constitutional  effects  of  mercury.     If  given  in  larger 
doses  it  acts  as  a  cathartic. 

Dose  and  Mode  of  Administration. — The  usual  form  in  which  it  is 
administered  is  that  of  pill — or  the  blue  mass  may  be  given  diffused 
through  some  mucilaginous  vehicle.  The  dose  is  from  4  to  5  grs. 
repeated  once  or  twice  a  day.     Tn  doses  of  15  or  20  grs.  it  purges. 

3.  Hyd.  cum  Creta. — This  is  mercury  in  combination  with  chalk? 
and  is  prepared  by  triturating  three  parts  of  mercury  with  five  parts  of 
prepared  chalk  until  globules  are  no  longer  visible.  It  is  in  the  state 
of  a  greyish  powder. 

Chemical  Composition. — 8  grs.  of  this  preparation  contain  3  grs.  of 
mercury.  The  state  in  which  the  mercury  exists  here  is  simply  one  of 
minute  division. 

Effects. — This  is  the  mildest  of  all  the  mercurial  preparations.  In 
iits  general  operation  it  is  the  same  as  the  blue  pill.  The  addition  of 
lihe  chalk  is  supposed  to  render  the  preparation  milder.  From  the 
great  mildness  of  this  article  it  is  exceedingly  valuable  as  an  alterative 
"for  children. 

Dose. — From  5  to  20  grs.  twice  a  day.     Children,  2  or  3  grs. 

4.  Unguentum  Hydrargyri. — This  is  the  blue  ointment,  and  is 
•prepared  'by  rubbing  up  pure  quicksilver  with  lard  until  globules  are 
■no  longer  visible.  There  are  two  kinds  of  this  ointment  used — the 
strong  and  the  mild — the  former  contains  half  its  weight  in  mercury, 
the  latter  one-sixth.  In  this  preparation  mercury  exists  in  the  same 
state  in  which  it  does  in  the  blue  mass  and  the  hyd.  cum  creta.  The 
strong  mercurial  ointment  alone  is  used  in  New  York. 

Effects. — Rubbed  on  the  surface  it  produces  all  the  constitutional 
effects  of  mercury.  If  you  wish  to  salivate  speedily  half  a  drachm  may 
be  rubbed  in  the  skin  every  hour,  marking  the  effect  each  time  and  vary- 
ing the  seat  of  application.  If  you  do  not  wish  to  excite  salivation  so 
speedily  3  ss  or  3  i  every  night  and  morning  will  answer.  The  parts 
best  suited  for  the  application  are  where  the  cuticle  is  the  thinnest, 
:as  the  inside  of  the  thigh,  and  it  is  best  to  do  it  before  a  fire,  to  liquify 
the  ointment  and  promote  absorption.  The  occasional  use  of  the  warm 
bath  promotes  its  operation  ;  where  a  second  person  has  to  perform  the 
friction,  the  best  mode  is  to  cover  the  hand  with  a  pig's  bladder,  turned 
inside  out. 

:5.  Oxides  of  Mercury. — (a)  Protoxide. — This,  in  the  pharmaceutical 
language,  is  known  by  the  name  of  the  Oxydum  Hydrargyri  Cinereum, 
and  by  the  common  names  of  the  black,  grey,  or  ash-colored  oxide. 

Properties. — It  is  a  dark  colored  powder,  varying  in  its  shades,  some- 


8IALAG0GUEH.  189 

times  black,  at  others  grey,  or  ash-colored.     It  is  destitute  both  of  ti 
and  smell.     In  water  it  is  insoluble. 

Chemical  Composition. — As  found  in  the  shops,  it  varies  considerably 
in  its  composition,  and  to  this  is  owing  the  difference  in  color.  The 
principal  ingredient  is  the  protoxide.  Besides  this,  however,  it  contains 
frequently  calomel,  peroxide,  and  metallic  mercury.  The  first  of  these — 
calomel,  arises  from  the  imperfect  decomposition  of  that  salt  in  the  ori- 
ginal preparation.  A  portion  of  the  calomel  remains  undecomposed, 
and  this  mixing  with  the  protoxide  gives  it  the  peculiar  grey  color.  The 
other  ingredients  arise  from  the  action  of  light  npon  the  black  oxide. 
On  exposure  to  light,  a  portion  of  it  loses  its  oxygen,  and  is  reduced  to 
the  metallic  sla  te,  while  the  same  oxygen  goes  on  to  another  portion,  and 
forms  the  peroxide.  The  combination  of  peroxide  with  the  black  oxide 
gives  the  whole  an  olive  color. 

Physiological  Effects. — This  is  a  mild  preparation  of  mercury,  pro- 
ducing the  general  effects  of  the  drug  on  the  system.  A  great  objec- 
tion to  it  is  the  variable  nature  of  its  composition. 

Dose. — From  one  to  three  or  four  grains,  twice  a  day.  It  is  very  lit- 
tle used. 

6.  Red  Precipitate. — Hydrargyri  nitrico-oxidum. — This  is  prepared 
by  taking  purified  mercury,  nitric  acid,  and  distilled  water,  and  boiling 
them  in  a  glass  vessel  until  the  mercury  is  dissolved.  Then  evaporate 
the  water,  when  a  white  mass  will  be  left.  Rub  this  into  powder,  and 
put  it  into  a  shallow  vessel,  then  apply  a  gentle  heat,  and  gradually  in- 
crease it  until  red  vapors  cease  to  arise. 

Properties. — When  properly  prepared,  this  is  of  a  bright  red  color, 
and  shining  scaly  appearance.  It  is  without  smell,  but  has  an  acid 
metallic  taste.  When  pure  it  is  perfectly  insoluble,  but  as  it  generally 
contains  a  little  nitrate  of  mercury,  it  is  slightly  soluble  in  water ;  at  a 
red  heat  it  is  decomposed  ;  oxygen  is  given  off,  and  metallic  mercury 
produced  and  vaporized. 

Effects. — From  the  great  activity  of  this  article  it  is  not  used  internally. 
When  accidentally  taken,  it  proves  irritant  and  poisonous.  It  is  only 
used  as  a  local  application.  In  its  pure  state  it  acts  as  an  escharotic, 
and  in  the  form  of  powder  is  applied  to  chancres,  indolent  ulcers,  <fce. 
The  more  common  form  is  that  of  ointment.  Red  ox.  3  j  ung.  simp. 
3  vij  M.  intime.  This  may  be  diluted,  if  too  strong,  with  lard.  If  kept 
it  turns  black,  owing  to  the  peroxide  changing  to  protoxide — good  sti- 
mulating ointment  to  change  the  character  of  ulcers. 

Unguentum  Nitratis  Hydrargyri. — Commonly  known  by  the  name  of 
Citrin  Ointment.  Prepared  by  dissolving  mercury  in  nitric  acid,  and 
then  adding  a  certain  proportion  of  lard  and  oil  while  the  solution  is 
hot.     Here  the  metal  is  first  oxidized  by  a  decomposition  of  part  of  the 


190  MATERIA   MEDICA   AND   THERAPEUTICS. 

nitric  acid,  and  then  combined  with  the  remainder,  making  a  nitrate  of 
mercury.  The  salt  first  formed  is  a  pernitrate  ;  by  the  action  of  the 
fat  and  oil  it  is  partially  decomposed  and  reduced  to  a  protonitrate. 

Properties. — When  recently  prepared  of  a  beautiful  yellow  color,  and 
of  the  consistency  of  butter.  By  keeping  it  acquires  a  dirty  greenish 
color,  and  becomes  hard  and  friable ;  neatsfoot  oil  preserves  its  proper- 
ties.    Hence,  in  the  TJ.  S.  made  with  a  proportion-  of  this. — TJ.  S.  Disp. 

Effects. — A  stimulant  and  alterative  application,  and  used  in  a  great 
number  of  local  affections.  In  chronic  diseases  of  the  skin,  ophthalmia 
tarsi.     To  be  diluted  according  to  the  effect  desired.- 

1.  Chlorides. — Of  these  there  are  two — the  perchlwide  and  the  pro- 
tochloride. 

Perchloride  of  Mercury. — This  is  corrosive  sublimate. 
Preparation. — Corrosive  sublimate  is  prepared  by  boiling  purified  mer- 
cury with  sulphuric  acid,  until  it  becomes  dry.  This  is  then  triturated 
with  muriate  of  soda  (chloride  of  sodium),  and  sublimed  by  a  strong- 
heat.  The  object  of  the  first  part  of  this  process  is  to  form  a  persulphate 
of  mercury  ;  in  the  second  part,  the  sodium  is  converted  into  soda,  by  the 
oxygen  of  the  peroxide  of  mercury.  This  then  unites  with  the  sulphuric 
acid,  and  forms  sulphate  of  soda,  which  remains  at  the  bottom  of  the 
vessel.  In  the  meantime,  the  chlorine  unites  with  the  mercury,  and 
forms  the  bi-chloride  of  mercury,  which  is  sublimed. 

Properties. — Thus  obtained,  corrosive  sublimate  is  a  semi-transparent 
crystalline  mass;  its  specific  weight  is  5*2.  It  is  destitute  of  smell,  and 
has  an  acrid  and  nauseous  taste.  It  dissolves  in  twenty  parts  of  cold 
water  and  about  three  times  its  weight  of  boiling  water.  In  alcohol,  it 
is  much  more  soluble ;  although  light  has  no  action  on  the  salt  itself, 
yet  an  aqueous  solution  of  it  is  decomposed  by  exposure  to  it.  The 
proto-chloride  of  mercury  is  precipitated,  and  muriatic  acid  is  formed  in 
the  solution.     Totally  volatilized  by  heat. 

Chemical  Composition. — Corrosive  sublimate  consists  of  two  propor- 
tionals of  chlorine  36  X  2  =  72,  and  one  proportional  of  mercury  200  = 
272. 

Effects. — These  vary  with  the  dose  and  mode  in  which  it  is  used.  In 
small  doses,  it  produces  no  immediate  or  manifest  effects  on  the  system. 
If  continued,  however,  a  considerable  length  of  time,  it  developes  all  the 
ordinary  effects  of  mercurials,  in  the  way  of  excitement  and  sometimes 
salivation.  If  the  dose  be  somewhat  increased,  it  acts  as  a  local  irritant, 
causing  griping  and  purging.  It  does  not  so  speedily  produce  saliva- 
tion as  the  other  preparations  of  mercury.  Externally  applied,  it  is 
stimulant  and  escharotic.  In  large  closes,  it  acts  as  a  virulent  and  cor- 
rosive poison. 

Mode  of  Administration. — 1.  Pill.     This  is  the  ordinary  form  and  a 


SIALAGOGUES.  ] '.) I 

very  good  one.  Tt  may  be  rubbed  up  with  an  equal  portion  of  muriate 
of  ammonia,  and  made  into  a  mass  with  crumbs  of  bread.  Each  pill 
may  contain  -(\  ori  of  a  grain,  to  be  taken  twice  ;i  day. 

2.  .Solution. — Dissolved  in  water  or  alcohol,  it  is  also  given  internally 

in  the  same  quantity. 

3.  As  a  local  application,  it  is  used   in   two  forms :    1.   tn  the 
simple  solution,  about  grs.  ij  of  the  sublimate  being  dissolved  in   §   viij 
of  water,  and  sweetened  with  honey.      In  this  way  it  is  used  as  a  local 
application  to  remove  ulcers  in  the  throat. 

2.  The  Yellow  Wash. — This  is  prepared  by  adding  lime  water  to 
<  corrosive  sublimate  in  the  proportion  of  grs.  i  to  iij  to  the  ounce.  Eere 
a  hydrated  peroxide  of  mercury  is  thrown  down,  and  tin;  chloride  of 
calcium  is  in  solution.  It  is  therefore  a  solution  of  the  chloride  of  cal- 
cium mixed  with  peroxide  of  mercury.  This  was  formerly  called  the 
aqua  phagedenica,  and  is  much  used  as  a  local  application  to  venereal 
and  phagedenic  ulcers. 

8.  Calomel. — This  is  the  proto-chloride  of  mercury,  commonly  known 
under  its  old  chemical  name  of  the  sub-muriate,  also  the  mild  muriate 
of  mercury. 

Modes  of  Preparation. — These  vary.  I  shatf  give  that  of  our  own 
pharmacopoeia.  Take  of  mercury  four  pounds,  sulphuric  acid  three 
pounds,  chloride  of  sodium  a  pound  and  a  half,  distilled  water  a  sufficient 
quantity ;  boil  two  pounds  of  the  mercury  with  the  acid,  until  the  sul- 
phate of  mercury  is  left  dry ;  rub  this  when  cold  with  the  remainder  of 
the  mercury  in  an  earthenware  mortar  till  they  are  thoroughly  mixed, 
then  add  the  chloride  of  sodium,  and  rub  it  with  the  other  ingredients 
till  all  the  globules  disappear;  afterwards  sublime.  Reduce  the  sub- 
limed matter  to  a  very  fine  powder,  and  wash  it  frequently  with  boiling 
distilled  water,  till  the  washings  afford  no  precipitate  upon  the  addition 
of  solution  of  ammonia,  then  dry  it 

Tests  of  its  Purity. — Entirely  dispersed  by  heat.  Sulphuric  ether 
agitated  with  it,  and  then  filtered  and  evaporated,  leaves  no  crystalline 
residuum,  and  what  residuum  may  be  left  is  not  turned  yellow  by  aqua 
potassaa. — Phar.  Ed. 

Physiological  and  Therapeutical  Effects. — Upon  these  I  will  not 
dwell.  Having  in  my  general  remarks  on  mercury  usually  referred  to 
calomel  as  the  particular  mercurial  by  which  the  best  effects  of  the  metal 
can  be  secured,  all  that  I  could  now  say  would  be  but  a  repetition  of 
what  has  gone  before.  A  few  words  on  some  of  its  more  useful  combi- 
nations and  its  local  application  are  all  that  seems  necessarv.  Combined 
with  Dover's  powder,  calomel  is  one  of  our  most  reliable  diaphoretics. 
Equal  parts  are  commonly  given  ;  the  proportions  may,  of  course,  vary 
according  to  circumstances. 


192 


MATERIA   MEDICA    AND    THERAPEUTICS. 


Calomel  and  squills,,  one  grain  each  in  pill,,  has  few  equals  as  a  diure- 
tic ;  it  should  be  pushed  to  a  gentle  salivation,  unless  free  diuresis  occur 
before.  Combined  with  the  golden  sulphuret  of  antimony  and  gum 
guaiac.  (Plurnmer's  pill),  calomel  is  much  used  as  an  alterative  in  chronic 
diseases  of  the  skin. 

Local  Use. — Calomel  is  used  locally,  either  alone  or  in  the  form  of 
black  wash.  Powdered  calomel  blown  into  the  eye  is  an  approved  re- 
medy in  opacities  of  the  cornea.  Rubbed  up  with  lard  it  is  applied  to 
ulcers  as  a  mild  stimulant.  The  black  wash,  made  by  adding  calomel, 
.  3i,  to  lime  water  3  viij,.  is  an  excellent  application  to  irritable  sores, 
excoriations,  &c,  &c.     It  is  used  very  generally  in  gonorrhoea. 

Dose. — When  given  as  an  alterative,  half  a  grain  to  one  grain  twice 
a  day ;  to  produce  salivation,  two,  three,,  or  five  grs.  three  times  a  day  ; 
as  a  purgative,  grs.  x  to  grs.  xx. 

[It  has  been  of  late  proposed  to  give  calomel  in  very  minute  doses, 
tV  t°  2T¥  gram  every  hour,  to  produce  rapid  salivation.  It  is  said  to 
have  touched  the  gums  in  twenty-four  hours. — Ei>.] 


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DIAPIIOEETICS 


The  term  Diaphoretic  is  applied  to  that  class  of  medicinal  agents 
•which  possesses  the  power  of  increasing  the  natural  exhalation  from  the 
skin.  When  this  is  carried  to  the  extent  of  producing  actual  sweating, 
they  are  sometimes  denominated  Sudorifics.  The  terms,  however,  are 
generally  used  indiscriminately — and  in  reality  the  distinction  is  a  mat- 
ter of  no  great  consequence,  as  the  difference  between  them  is  only  in 
the  degree  of  effect  produced.  What  shows  this  conclusively  is,  that,  if 
what  are  strictly  called  diaphoretics  be  given  in  increased  doses,  a  sudo- 
rific effect  may  be  produced,  and  vice  versa.  In  the  case  of  diaphoresis, 
the  discharge  from  the  skin  passes  off  in  the  form  of  insensible  vapor, 
■while  in  the  case  of  sweating  it  is  in  the  state  of  a  fluid.  The  class  of 
agents,  therefore,  of  which  we  are  now  to  treat  are  those  which  increase 
the  discharge  from  the  skin,  whether  this  be  in  the  form  of  vapor  or 
fluid. 

The  modes  in  which  a  diaphoretic  or  sudorific  effect  may  be  pro- 
duced are  various.  In  some  cases,  it  is  produced  by  agents  which  have 
a  tendency  to  relax,  and  debilitate  the  system  ;  in  others,  again,  by 
those  agents  which  stimulate.  Sometimes,  it  is  produced  by  agents 
taken  internally ;  while  in  others,  by  those  acting  directly  upon  the 
skin. 

Effects  of  Diaphoretics. — Acting  on  a  surface  so  extensive  as  the 
skin,  and  producing  frequently  very  copious  evacuations  from  it,  it  is 
evident  that  diaphoretics  must  cause  very  important  changes  in  the 
system.     Among  these  the  following  are  the  most  striking : — 

1.  They  change  the  state  of  the  Circulation. — From  the  increased  de- 
termination of  blood  which  takes  place  to  the  surface  during  the  process 
of  perspiration,  it  is  manifest  that  the  quantity  of  that  fluid  in  other 
parts  of  the  system  must  be  diminished.  Ilence  it  is  that  in  cases  of 
internal  congestions,  as  soon  as  free  perspiration  is  brought  about,  relief 
is  obtained.  In  this  way,  a  more  equal  and  uniform  distribution  of  the 
circulating  fluid  is  produced.  With  regard  to  the  action  of  the  heart 
and  arteries,  the  effect  of  sudorifics  must  necessarily  differ,  according  to 
the  character  of  the  article  used.     If  it  be  stimulating,  the  heart's  action 


194  MATERIA    MEDICA   AND   THERAPEUTICS. 

will  be  increased,  and  the  pulse  will  become  fuller  and  more  frequent, 
and  vice  versa.  The  effect  of  mere  sweating,  however,  upon  the  vascu- 
lar system  is  to  diminish  action.  Hence,  under  the  operation  of  sudo- 
rifics  which  are  not  stimulating,  the  pulse  becomes  slower  and  softer ; 
and  if  the  .sweating  be  carried  too  far  it  becomes  weak,  tremulous,  and 
frequent. 

"With  regard  to  the  effects  of  sweating  on  the  blood  itself,  it  is  evident 
that  it  must  diminish  the  quantity  of  that  fluid.  It  might  naturally  be 
supposed,  too,  that  it  would  have  a  tendency  to  render  the  blood  thicker 
by  draining  off  the  thinner  or  serous  part.  This,  however,  is  not  found 
to  be  the  case,  doubtless  because  the  loss  is  promptly  supplied  by  the 
absorption  of  watery  fluids  by  the  blood-vessels. 

2.  Sudorifics  produce  a  change  in  the  condition  of  the  Skin. — Under 
their  influence  not  merely  an  increased  flow  of  blood  takes  place  to  the 
surface  but  the  condition  of  the  exhaling  vessels  is  changed,  according 
to  the  previous  condition  of  the  skin  and  the  kind  of  sudorific  agent 
which  is  used.  Thus,  if  there  be  a  great  degree  of  general  excitement 
present,  and  the  skin  be  hot  and  dry,  the  effect  of  debilitating  sudorifics 
will  be  to  cause  diminished  action  and  relaxation  of  the  cutaneous  ves- 
sels. If,  on  the  other  hand,  the  skin  be  cold,  dry,  and  torpid,  and  sti- 
mulating sudorifics  be  administered,  there  will  be  increase  of  action  in 
the  cutaneous  vessels.  Besides  this  mere  increase  and  diminution  of 
action,  there  is  every  reason  to  believe  that  under  the  use  of  certain 
ao-ents,  a  new  action  is  set  up  in  the  capillaries  of  the  surface,  producing 
an  alterative  effect. 

3.  Sudorifics  produce  a  change  in  the  Temperature  of  the  Body.— -The 
necessary  effect  of  sweating  is  to  lessen  the  animal  heat,  and  the  extent 
to  which  this  is  carried  is  of  course  proportioned  to  the  duration  of  the 
process  and  the  quantity  of  fluid  which  is  lost.  The  effect  thus  pro- 
duced is  obvious  to  the  senses,  and  may  be  easily  appreciated  by  a  pro- 
per thermometer.  Thus,  if  the  natural  heat  at  the  commencement  of 
perspiration  be  at  108°  or  110°,  after  this  process  has  continued  for  six 
or  seven  hours,  the  thermometer  will  hardly  be  raised  to  blood  heat. 

4.  Sudorifics  produce  a,  change  in  the  conditions  of  various  portions 
of  the  Mucous  Membrane. — During  the  operation  of  sudorifics  the  flow 
of  blood  is  diverted  from  the  mucous  tissue,  and  the  secretions  from  it 
are  generally  diminished.  Thus  in  the  mouth  and  fauces  dryness  and 
thirst  are  produced.  The  most  striking  illustration  of  this,  however,  is 
noticed  in  the  intestines.  Between  these  and  the  skin  there  is  a  won- 
derful sympathy.  Thus,  if  perspiration  be  suddenly  checked,  diarrhoea 
frequently  occurs.  So  also  during  the  operation  of  an  ordinary  cathar- 
tic, the  skin  becomes  cool,  dry,  and  torpid.  On  the  other  hand,  free 
perspiration  interferes  with  the  due  operation  of  a  cathartic,  and  checks 
the  determination  to  the  bowels.     The  same  holds  good  in  relation  to 


DIAPHORETICS.  105 

the  mucous  membrane  of  the  lungs.  Eence  it  is  that  a  warm  climate 
and  all  those  agents  which  act  on  the  skin  are  so  I"  aeficial  in  certain 
affections  of  this  membrane. 

5.  Sudorific*  produce  a  change  in  the  condition  <>/  the  Urinary  Or- 
gans.— The  Sympathy ' between  ElTe  skin  ;wi<l  kidneys  is  perhaps  still 
more  striking  than  that  between  the  .skin  and  bowels.  Whei 
therefore,  the  perspiration  is  increased,  the  urine  is  diminished  in  quan- 
tity, and  vice  versa.  In  the  healthy  condition  of  the  Bystem  this  fact  is 
continually  illustrated  under  the  ordinary  changes  of  the  atmo  phere. 
In  winter,  when  the  perspiration  is  less,  the  quantity  of  urine  is  always 
greater  than  in  summer.  Under  the  action  of  diaphoretics  the  urinary 
secretion  is  always  lessened. 

6.  Sudor  ifics  produce  a  general  debilitating  effect  on  the  System. — 
During  the  free  opcratiorTbf  sudorifics  the  nervous  energy fnd  muscular 
strength  are  both  impaired,  in  proportion  to  the  extent  of  the  sweating. 
The  debility  thus  induced  is  frequently  much  greater  and  more  fell  by 
the  constitution  than  a  large  bleeding  (Alexander,  p.  174).  This  need 
excite  no  surprise  when  we  reflect  upon  the  extensive  depletion  which 
the  system  may  undergo  during  this  process  if  continued  for  any  lei 

of  time.  Of  this  some  idea  may  be  formed  if  we  recollect  how  much  is 
lost  under  ordinary  circumstances  in  a  state  of  health.  From  the  expe- 
riments of  Lavoisier  and  Seguin  it  appears  that  the  average  of  insei 
perspiration  amounts  to  about  eighteen  grains  in  the  minute,  or  three 
pounds,  three  ounces,  and  one  hundred  and  sixty  grains  troy  in  twenty- 
four  hours.     (Thomson,  vol.  ii.  p.  473.) 


CIRCUMSTANCES    MODIFYING    THESE    EFFECTS. 

Age. — From  the  progressive  change  which  the  skin  undergoes  from 
infancy  to  old  age,  it  is  evident  that  its  functions  will  also  vary,  and,  of 
course,  that  the  effects  of  medicinal  agents  upon  it  will  be  greatly  modi- 
fied. In  a  state  of  health,  as  a  general  rule,  children  sweat  less  than 
adults,  and  in  them  it  is  much  more  difficult  to  excite  perspiration  in 
cases  of  disease.  This  is  probably  owing  to  the  great  rapidity  of  the 
circulation  in  early  life.  In  old  age  the  cutaneous  secretion  is  also  less 
than  in  the  middle  age.  The  capillaries  of  the  surface  become  torpid 
and  inactive. 

Climate. — The  effect  of  climate  ou  the  skiu  is  peculiar  and  striking. 
In  cold  regions  the  skin  becomes  dry,  hard,  and  thick — losing  the  plia- 
bility and  delicacy  of  touch  which  characterizes  it  in  temperate  and 
warm  latitudes.  As  a  matter  of  course,  agents  designed  to  excite  the 
functions  of  the  skin  cannot  be  so  effective.  It  will,  accordingly,  be 
found  that  diaphoretics  do  not  produce  the  same  effects  in  cold  regions 


196  MATERIA   MEDICA   AND  THERAPEUTICS. 

that  they  do  in  warmer  ones.  Sir  George  Balinghall  remarks,  that  in 
the  East  Indies  much  smaller  doses  of  sudorifics  produced  the  desired 
effects  than  were  necessary  in  a  colder  climate.  In  this  way,  too, 
perhaps,  may  be  explained  the  great  success  attending  the  use  of  various 
stimulating  sudorifics,  such  as  Guaiac,  Mezereon,  &c,  curing  the  vene- 
real disease  in  the  West  Indies,  which  they  have  failed  to  do  in  other 
regions. 


CONDITION    OF    THE     SYSTEM     NECESSARY    TO     PRODUCE    THE    EFFECTS     OF 

DIAPHORETICS. 

Unlike  many  other  medicinal  agents,  the  effects  of  diaphoretics  cannot 
be  secured  ujpder  every  condition  of  the  system.  Emetics  and  cathar- 
tics may  be  made  to  produce  their  effects  as  a  general  rule  under  almost 
any  circumstances.  Not  so  diaphoretics.  Unless  the  system  be  in  a 
state  favorable  to  their  action,  little  or  no  effect  is  produced.  Hence  it 
is  that  they  have  been  looked  upon  as  remedies  very  uncertain  in  their 
character,  and  by  many  have  been  in  a  great  measure  rejected.  This 
isr  however,  altogether  an  erroneous  view  of  the  subject.  That  diapho- 
retics are  uncertain,  if  carelessly  used,  is  very  true.  If,  on  the  other 
hand,  they  are  used  with  due  regard  to  certain  conditions  of  the 
system,  thev  are  by  no  means  uncertain,  and  become  remedial  agents  of 
great  power.  Under  these  circumstances,  it  is  essential  to  ascertain  and 
fix,  if  possible,  the  precise  state  of  the  animal  economy,  most  favorable 
to  their  operation.  As  the  result  of  observation  and  experiment,  it 
has  been  established  that  to  secure  the  favorable  and  efficient  action 
of  sudorifics,  there  are  two  things  which  require  specially  to  be  attended 
to;  and  these  are,  the  degree  of  animal  heat  and  the  state  of  circu- 
lation. 

From  a  series  of  well  conducted  experiments  made  long  since  by  Dr. 
Alexander,  of  Edinburgh,  the  fact  was  established  that  a  certain  degree 
of  heat,  which  he  calls  the  "  sweating  point,"  is  absolutely  necessary  to 
produce  sweating ;  and  the  further  the  heat  of  any  person  is  advanced 
above,  or  reduced  below,  this  standard,  the  further  is  he  removed  from 
any  possibility  of  sweating.*  Although  it  is  reasonable  to  suppose  that 
this  standard  of  heat  must  differ  somewhat  in  different  individuals,  yet 
Dr.  Alexander  states,  as  the  result  of  his  trials,  that  it  is  commonly  six, 
eio-ht,  or  ten  degrees  above  what  is  natural  to  the  constitution  in  perfect 
health.f 

By  others  the  degree  of  heat  favorable  to  perspiration  is  placed  some- 

*  Experimental  Essays.     By  Wm.  Alexander,  M.D.     London:  1770.     P.  165. 
•J-  Ibid.  p.  205. 


DIAPHORETICS.  I'jI 

what   lower.       Dr.  Dewees  puts  it  only  two   or  four  degrees  above  the 
natural  standard,  which  is  9.s°.'/:     Perhaps  from  four  to  six  degre* 
nearer  the  truth  than  either.     Now  just  in  proportion  as  the  heal  of  the 
system  is  raised  above  or  reduced  below  this  point,  will  be  the  difficulty 
of  producing  perspiration. 

Besides  a  certain  degree  of  heat,  a  certain  condition  of  the  vascular 
system  is  also  necessary  to  insure  the  operation  of  diaphoretics.  If  the 
pulse  be  hard,  strong,  and  frequent,  as  it  is  in  febrile  and  inflammatory 
complaints,  all  attempts  at  producing  sweat  will  be  unavailing.  On  the 
other  hand,  when  the  pulse  is  oppressed  and  the  circulation  slower  than 
natural,,  as  it  is  in  certain  congested  states  of  the  system,  the  same  diffi- 
culty  will  occur. 


RULES  TO  BE   OBSERVED  IN  THEIR  APPLICATION. 

To  secure  the  operation  of  diaphoretics,  regulate  the  circulation  and 
the  degree  of  animal  heat,  so  as  to  bring  the  system  within  the  range 
favorable  to  the  process  of  perspiration.  If  the  pulse  be  full,  hard,  and 
frequent,  this  should  be  corrected  by  venesection,  cathartics,  &c,  accord- 
ing to  the  particular  circumstances  indicated  by  the  case.  Attend  also 
to  the  heat  of  the  body ;  whenever  the  degree  of  heat  is  above  102°  or 
104°  reduce  it  by  appropriate  means.  For  this  purpose  venesection  and 
evacuants  may,,  in  some  cases,  be  necessary.  When  these  are  not  re- 
quired, the  free  use  of  cold  water  will  answer  the  purpose,  So  decided- 
]y  does  this  operate  in  lowering  the  temperature,  that  it  frequently 
brings  on  sweating  without  any  other  means.f  On  the  other  hand, 
where  the  degree  of  heat  is  too  low,  warm  drinks  will  be  required 
to  raise  it.J  If,  during  the  use  of  diaphoretics,  purging  or  diar- 
rhoea be  present,  it  frequently  happens  that  everything  given  to  pro- 
duce diaphoresis  only  increases  the  intestinal  discharges.  In  these 
cases  opium  may  be  resorted  to  with  the  double  advantage  of  checking 
the  diarrhoea  and  determining  to  the  surface.  If  it  be  found,  as  is  some- 
times the  case  when  giving  diluents  and  other  articles  to  promote  per- 
spiration, that  a  determination  of  fluids  is  taking  place  to  the  kidneys, 
the  best  plan  is  to  desist  from  the  use  of  internal  remedies ;  and  to  trust 
to  external  applications  to  accomplish  their  object,  or  to  rely  on  opiate 
diaphoretics.  During  the  use  of  diaphoretics  the  patients  should  be  kept 
in  bed,  and  both  the  body  and  bed  covering  should  be  of  flannel.  This 
is  a  bad  conductor  of  heat  and  keeps  up  a  uniform  temperature  around 
the  body,  at  the  same  time  that  it  absorbs  moisture.  To  gain  the  full 
effect  of  this  class  of  remedies,  their  use  njust  be  accompanied  by  plenti- 

*  Practice,  v.  i.  p.  78.  f  Alexander,  p.  163.  %  Alexander,  p.  205. 


r 


198  MATERIA    MEDICA    AND   THERAPEUTICS. 

ful  dilution.  Unless  this  is  done,  the  effect  on  the  skin  is  soon  suspend- 
ed. With  regard  to  the  kind  of  diluent  to  be  used,  that  must  be  deter- 
mined by  the  state  of  the  system.  If  the  temperature  be  above  the 
"  sweating  point,"  then  cold  drinks  are  proper;  if,  on  the  other  hand, 
it  is  below  that  standard,  they  are  to  be  used  warm. 

Diaphoretics,  like  soporifics,  generally  operate  better  if  given  about 
the  usual  time  of  going  to  sleep,  hord  somni.  At  this  time  there  is 
generally  such  a  tendency  to  relaxation  and  to  sweating,  that  diaphore- 
tics will  operate  with  more  power  and  more  certainty. 

When  perspiration  is  to  be  arrested,  it  is  not  to  be  clone  by  the  use 
of  cold  drinks  or  by  the  application  of  cold  to  the  surface,  but  by  rub- 
bing the  patient  dry  and  gradually  removing  his  covering. 


MODES    IN    WHICH    DIAPHORETICS    PROVE    CURATIVE. 

They  change  the  distribution  of  the  blood,  equalize  the  circulation, 
and  relieve  internal  congestion.  They  deplete  the  system — they  change 
the  condition  of  the  skin  ;  from  hot  and  dry  it  becomes  cool,  soft,  and 
moist — they  lower  animal  heat. 

By  some  eminent  authors  the  direct  curative  power  of  diaphoretics  is 
altogether  denied.  Dr.  Holland*  states  that  the  improvement  that  often 
follows  their  use  depends  not  on  their  direct  influence  on  exhalation,  but 
on  other  changes  which  they  produce  on  the  system,  and  of  course  that 
diaphoresis  is  of  no  further  importance  than  as  proving  the  action  of  the 
remedy  on  the  system.  [This  opinion  is  common  among  our  best  prac- 
titioners.— Ed.] 


PRACTICAL    APPLICATIONS. 

1.  Fevers. — As  you  probably  know,  there  is  no  class  of  remedies 
which  has  been  so  generally  popular  in  these  diseases  as  sudorifics.  This 
has  arisen  very  naturally  from,  the  fact  so  constantly  observed  that 
sweating  is  the  process  by  which  fevers,  when  left  to  themselves,  usually 
come  to  a  crisis.  You  see  this  very  strikingly  illustrated  in  ordinary 
intermittent  fevers. 

Accordingly,  in  all  ages,  and  amid  every  variety  of  doctrine  and  theo- 
ry in  relation  to  febrile  affections,  remedies  acting  on  the  skin  have  been 
resorted  to,  and  there  can  be  no  question  of  their  general  utility  and 
efficacy.  Like  all  others,  they  may  and  have  been  much  abused.  To 
enable  you  to  use  them  advantageously,  attend  to — 

*  Med.  Notes  and  Reflections,  p.  52. 


DIAPHOEETICS.  \'.)U 

The  Stage  of  the  Fever. — From  what  lias  been  already  Bald  of  the 
operation  and  effects  of  diaphoretics  in  general,  it  is  very  evidenl  thai 

the  first  sta^c  of  fever  is  very  unfavorable  to  their  exhibition.      The  li 

viscera  are  in  ;i  state  of  < gestion,  and  animal  temperature  is  usually 

below  the  point  favorable  to  perspiration.  To  excite  perspiration  under 
such  circumstances  is  exceedingly  difficult,  unless  it  be  'lone  by  Buch 
means  as  have  a  most  injurious  effect  upon  the  system,  i.  e.  b) 
of  a  heating  and  stimulating  character.  Among  the  older  physicians 
this  was  the  ordinary  practice,  and  all  sorts  of  stimulant?*  and  alexiphar- 
mics  (as  they  were  called)  were  freely  prescribed.  This  practice,  how- 
ever, has  entirely  gone  out  of  date.  The  stimulating  diaphoretics  are 
very  rarely  given  in  the  first  (cold)  stage  of  fever.  There  is  one  class  of 
these  remedies  which  may  very  often  be  given  even  in  this  stage — I 
mean  warm  teas,  their  operation  being  aided  and  their  action  directed 
to  the  skin  by  warm  covering. 

It  is  in  the  second  stage  of  fever  that  diaphoretics  may  be  used  with 
the  best  prospect  of  advantage;  but  to  secure  this,  attention  must  be 
most  particularly  directed  to  the  state  of  the  system  in  each  particular 
case,  and  should  the  patient  be  very  plethoric,  the  pulse  full  and  strong, 
and  the  animal  heat  above  the  sweating  point,  you  will  in  vain  attempt 
to  bring  on  diaphoresis.  In  all  these  cases,  therefore,  the  system  must 
be  brought  into  a  proper  state  by  appropriate  means,  and  when  this  has 
been  done,  it  is  frequently  surprising  how  readily  the  skin,  before 
obstinately  dry  and  constricted,  will  become  soft  and  moist.  Besides 
attending  to  the  circulation  and  the  temperature  of  the  body,  there  is 
another  point  of  very  great  practical  importance,  and  that  is  the  con- 
dition of  the  abdominal  viscera.  In  all  cases  these  should  be  thorouo-hly 
unloaded,  and  their  secretions  properly  regulated,  before  the  full  and 
beneficial  effects  of  sudorifi.es  can  be  obtained. 

In  the  use  of  the  remedies  to  accomplish  this  effect,  everythino-  must 
be  decided  by  the  particular  circumstances  of  the  individual  case.  If 
there  be  great  vigor  of  the  system,  and  an  active  circulation,  those 
should  be  selected  which  are  the  most  debilitating  in  their  operation, 
and  of  these  tartar  emetic  takes  the  lead.  [The  use  of  tartar  emetic  as 
a  diaphoretic  in  fever,  once  so  nearly  universal,  is  now  very  much  out  of 
date.  It  has  given  way  to  ipecac,  the  alkaline  carbonates,  and  spiritus 
mindereri.]  In  other  cases,  where  there  is  less  vascular  action,  and  the 
powers  of  the  system  more  reduced,  this  article  would  be  whollv  im- 
proper. Here  the  antimonial  powder  or  the  spiritus  mindereri  answer 
a  much  better  purpose,  or  if  prostration  be  very  considerable,  infusion  of 
snake  root  (Serpenlaria  virginiana)  and  wine  whey  are  the  best  sudo- 
rifics. 

With  regard  to  the  use  of  opium  in  fever  as  a  sudorific,  I  can  only 
advise  you  to  be  cautious.     Its  ordinary  effect,  as  you  know,  is  to  restrain 


200  MATERIA    MEDICA    AND   THERAPEUTICS. 

all  the  secretions  of  the  system  except  those  of  the  skin,  and  as  your 
general  object  in  fever  is  to  keep  all  excreting  and  secreting  apparatus 
open,  it  may  prove  exceedingly  injurious.  The  best  form  is  that  of 
Dover's  powder.  Even  this,  however,  is  to  be  used  with  caution,  and 
only  where  the  previous  evacuation  has  been  free,  vascular  action 
feeble,  and  the  head  unaffected. 

Inflammations. — In  all  inflammatory  affections  determination  towards 
the  skin  has  a  salutary  effect.  It  equalizes  the  circulation — diverts  the 
currents  of  fluid  from  the  inflamed  organ — lessens  general  vascular 
excitement.  To  produce  such  a  salutary  determination  in  inflammation 
is,  however,  by  no  means  an  easy  task,  and  must  be  brought  about  by 
properly  preparing  the  system  at  first  by  appropriate  venesection,  purg- 
ing, and  the  like,  and  then  by  the  judicious  selection  of  appropriate 
sudorific  -agents.  As  a  matter  of  course  all  heating  and  stimulating 
articles  are  to  be  avoided,  and  such  only  used  as  have  the  effect  of 
repressing  excitement.  As  a  general  rule  the  agent  which  can  be  most 
■safely  trusted  in  these  cases  is  tartar  -emetic.  As  already  stated,  per- 
spiration can  only  take  place  when  the  heat  of  the  body  as  well  as  the 
vascular  excitement  is  brought  down.  Now,  when  this  has  been  accom- 
plished by  venesection  and  other  evacuant  remedies,  tartar  emetic  in 
repeated  doses  has  an  admirable  effect  in  keeping  down  the  excitement 
permanently,  and  thus  preserving  the  system  in  the  state  appropriate  to 
cutaneous  determination.  In  this  way  this  remedy  acts  in  a  double 
capacity  as  a  sudorific.  In  other  cases  where  the  excitement  has  been 
properly  subdued,  milder  articles  may  answer  every  purpose.  [Espe- 
cially may  we  rely  on  ipecac,  as  on  the  one  hand  safe  in  cases  attended 
with  considerable  excitement,  and  on  the  other  not  likely  to  produce 
the  mischievous  effects  which  tartar  emetic,  even  when  carefully 
watched,  will  every  now  and  then  cause.  The  proportion  of  cases  of 
inflammation  in  which  ipecacuanha  can  be  wisely  substituted  for  tartar 
emetic,  is  pretty  sure  to  increase  upon  us  as  we  grow  older.  The  young 
doctor  despises  ipecacuanha  and  admires  tartar  emetic.  The  old  doctor 
fears  tartar  emetic  and  trusts  ipecacuanha. — Ed.] 

Diseases  of  the  Lungs. — There  is  no  class  of  affections,  perhaps,  in 
which  the  agency  of  those  remedies  which  keep  up  a  determination  to  the 
skin  is  more  marked  or  decided  than  certain  affections  of  the  chest, 
more  especially  those  of  a  chronic  character.  Among  these,  pulmonary 
consumption  will  serve  as  a  striking  illustration. 

The  treatment  of  phthisis  by  diaphoretics,  and  especially  by  the 
depressing  diaphoretics,  has  gone  almost  entirely  out  of  fashion  among 
us.  The  dependence  of  the  disease  upon  depraved  nutrition,  now  a  fact 
in  science,  has  banished  from  practice  the  sudorifics  and  cough  mixtures 
in  which  our  predecessors  delighted. 

Dysentery. — This  is  a  disease  in  which  sudorifics  have  been  much 


niAPIIOKKTICS.  201 

lailded,  and  certainly  with  no  little;  justice.  The  functions  of  the  skin 
are  impaired,  while  a  great  determination  of  fluid   takes  place  towards 

the  liver  and  intestines.  By  causing  a  derivation  to  the  skin  this 
abdominal  congestion  is  relieved,  and  if  accompanied  with  other  appro- 
priate treatment  it  may  prove  most  efficacious  in  eventually  breaking  up 
the  disease.  From  the  great  distress  and  intestinal  irritation  present  in 
this  disease,  the  best  article  which  can  be  selected  is  the  Dover's 
powder.  This  quiets  pain  and  irritation,  and  at  the  same  time  deter- 
mines powerfully  to  the  skin.  As  a  general  remedy  in  this  complaint 
there  is  none  which  is  so  efficacious.  It  may  be  used  either  alon.-, 
which  is  better  in  many  cases,  and  in  combination  with  calomel.  By 
this  combination  you  have  the  advantages  of  two  of  the  best  remedies 
that  I  know  of. 

INDIVIDUAL    DIAPHORETICS (EXTERNA  I.). 

1.  Friction. — Although  not  of  itself  capable  of  producing  perspiration, 
it  is  an  admirable  preliminary  in  many  cases  to  the  use  of  other  agents. 
It  awakens  the  sensibility  of  the  skin,  causes  a  new  determination  of 
blood  to  the  surface,  and  in  torpid  states  of  it  co-operates  most  advan- 
tageously and  powerfully  in  exciting  cutaneous  exhalation.  In  the  Turk- 
ish baths  the  use  and  effect  of  friction  are  strikingly  illustrated. 

2.  Water  applied  to  the  surface. — This  may  be  done  in  various  ways 
— by  affusion,  by  the  general  bath,  by  the  vapor  bath,  and  by  local 
applications  of  it. 

Water  may  be  applied  of  various  temperatures.  By  cold  water  we 
mean  water  of  a  temperature  ranging  from  40°  to  60°.  By  tepid  from 
35°  to  02°.     By  warm  from  92JJ  to  08°.     By  hot  from  98^  to  1  12°. 

By  affusion  we  mean  pouring  water  over  the  naked  body  of  the  patient. 
For  this  purpose  he  is  stripped,  seated  in  a  tub,  and  a  bucket  of  water 
poured  over  him.  If  necessary  it  may  be  repeated  three  or  four  times ; 
after  this  he  is  to  be  put  to  bed. 

Now  the  affusion  may  be  either  cold  or  tepid.  When  the  system  is 
laboring  under  febrile  excitement,  and  the  agent  is  properly  applied, 
the  effects  of  the  cold  affusion  are,  reduction  of  the  temperature  of  the 
body,  diminution  in  the  force  and  frequency  of  the  pulse,  frequently  of 
from  eight  to  twenty  pulsations  in  a  minute,  relaxation  of  the  skin  and 
mucous  surfaces,  and  finally  sleep. 

As  this  remedy  appears  to  act  as  a  direct  sedative,  lessening  animal 
heat  and  impairing  the  action  of  the  pulse,  it  is  requisite  in  using  it 
that  the  degree  of  heat  and  excitement  should  be  above  the  natural 
standard.  If  this  be  not  the  case,  so  far  from  acting  in  the  way  just 
mentioned,  it  will  produce  effects  entirely  different.  Instead  of  re- 
ducing heat  and  excitement  to  a  healthy  standard  and  eausing  salutary 


202  MATERIA   MEDICA   AND   THERAPEUTICS. 

perspiration,  it  will  unnaturally  subdue  the  actions  of  the  system  and 
reduce  the  powers  of  life. 

It  should  never  be  used  when  perspiration  is  actually  going  on. 
During  perspiration,  animal  heat  is  rapidly  diminishing.  To  apply 
cold  water  under  these  circumstances  might  increase  the  abstraction  of 
heat  to  so  great  a  degree  as  to  endanger  the  safety  of  the  patient. 
Besides  this,  the  sudden  check  given  to  perspiration  would  inevitably 
produce  dangerous  determinations  to  particular  organs,  at  a  time  when 
the  system  is  not  in  a  fit  condition  to  reach  and  relieve  these  deter- 
minations. 

Wherever  local  inflammation  exists,  the  cold  affusion  is  improper.  It 
necessarily  augments  the  local  difficulty  without  lessening  the  accom- 
panying excitements. 

Sometimes  the  tepid  affusion  is  used.  In  this  the  water  is  still  colder 
than  the  ordinary  temperature  of  the  body,  and  therefore  its  effect  in 
abstracting  heat  must  be  the  same  as  the  cold  affusion,  differing  only  in 
degree.  Its  general  operation  therefore  is  the  same.  It  lessens  heat — 
diminishes  the  frequency  of  the  pulse — relaxes  the  skin — promotes  per- 
spiration, and  creates  a  disposition  to  sleep.  Indeed,  it  sometimes 
appears  to  lessen  animal  heat  more  rapidly  than  the  cold  affusion,  inas- 
much as  it  causes  more  evaporation  from  the  surface.  Besides  this,  the 
tepid  affusion  does  not  cause  such  sudden  determinations  internally,  nor 
any  of  the  reaction  which  is  produced  by  the  cold  affusion.  On  this 
account  it  may  be  safely  used  in  many  cases  in  which  the  application 
of  cold  would  be  injurious,  as  in  inflammation,  &c. 

Besides  the  affusion,  water  is  also  applied  in  the  form  of  baths ;  jis 
diaphoretics  we  use  the  tepid^  loarm,  and  hot  baths. 

The  tepid  bath  ranges  from  85°  to  92°,  and  although  the  temperature 
is  lower  than  that  of  the  body,  yet  it  feels  warm,  because  the  surround- 
ing atmosphere  is  generally  below  this  point,  and  accordingly  the  body 
is  parting  with  more  caloric.  It  operates  very  much  like  the  tepid 
affusion — promotes  the  flow  of  blood  to  the  surface,  quiets  irritation, 
produces  a  soothing  influence  over  the  whole  system,  relaxes  the  skin, 
and  promotes  perspiration. 

The  warm  bath  ranges  from  92°  to  98°.  The  effect  of  this  is  some- 
what different.  At  first  it  renders  the  pulse  fuller  and  more  frequent, 
quickens  respiration,  and  promotes  perspiration;  speedily  it  leaves  the 
system  languid,  with  loss  of  muscular  power,  faintness,  and  disposition 
to  sleep.     It  is  more  stimulating  at  first  than  the  tepid  bath. 

The  hot, bath  ranges  from  98°  to  112°.  As  it  exceeds  the  heat  of 
the  body  its  effects  are  directly  and  powerfully  stimulating  in  proportion 
to  the  degree  of  heat.  The  rapidity  ancTforce  of  the  circulation  are 
increased — the  breathing  becomes  difficult — head  congested — the  sur- 
face red,  and  the  vessels  of  the  skin  distended.     In  the  course  of  half 


DIAPHORETICS.  208 

an  hour  or  so  perspiration  comes  on.     The  hot  bath  is  used  principally 

in  chronic  affections,  such  as  rheumatism,  paralysis,  &c.        its  effi 
should  he  carefully  watched. 

Hot  Water  locally  applied. — One  of  the  most  efficient  modes  is  a 
large  piece  of  flannel  wrung  out  of  boiling  water  and  wrapped  round 
the  legs  and  thighs.  This  excites  perspiration  very  Bpeedily  and 
certainly  even  when  other  more  complicated  means  fail,  in  -five  or  six 
minutes  after  the  application  perspiration  frequently  breaks  out. 
Another  advantage  attending  this  mode  is  that  it  does  so  with  I 
increase  of  heat  than  many  others.  In  an  experiment  made  by  Alexan- 
der, his  pulse  which  stood  at  72°  only  rose  to  7*7°,  and  the  thermometer 
at  the  pit  of  the  stomach,  which  stood  at  blood  heat,  only  rose  two 
degrees.  After  the  perspiration  had  continued  half  an  hour,  his  pulse 
fell  to  74°,  and  shortly  after  to  70°. 

Vapor  Bath. — The  simplest  mode  of  applying  the  vapor  bath  is  to 
fasten  a  blanket  round  the  patient's  neck  after  he  is  stripped,  so  as  to 
envelope  the  whole  body.  He  then  sits  down  on  a  low  stool  and  the 
blanket  is  closed  around  him  by  means  of  pins.  Under  the  blanket  is 
to  be  introduced  a  vessel  containing  some  simple  herbs  and  upon  which 
boiling  water  has  been  poured.  In  a  very  short  time  the  warm  vapor 
exuding  from  this  is  felt  by  the  patient — the  temperature  is  increased 
and  free  perspiration  soon  comes  on.  If  it  be  requisite  to  increase  or 
keep  up  the  heat,  hot  bricks  may  be  thrown  into  the  water  at  suitable 
intervals.  The  vapor  bath  is  more  powerfully  derivative  than  the  warra 
water  bath  and  consequently  more  certainly  diaphoretic,  but  at  the 
same  time  less  soothing  and  tranquillizing  [and  very  certain,  when  it 
does  no  good,  to  do  much  harm.  Its  immediate  effects  should  be 
closely  watched. — Ed.] 

3.  Air.  —  Heated  air  applied  to  the  surface  is  another  one  of  the 
most  powerful  modes  of  exciting  perspiration.  The  effect  of  warm 
climates  and  seasons  in  causing  perspiration  is  so  very  obvious  and 
striking  that  it  is  singular  that  no  greater  use  has  been  made  of  the 
artificial  application  of  hot  air.  It  was  not  until  recently  that  it  was 
even  thought  of.  In  1819  Dr.  Gower  contrived  what  he  called  a  suda- 
torium for  this  purpose.  This  consisted  of  an  oblong  wicker  arch, 
which  was  placed  over  the  patient  and  covered  with  blankets.  "  At 
the  end  of  this  frame  and  under  the  covering,  was  placed  a  lamp,  over 
which  rose  a  kind  of  chimney  or  tube,  which  conveyed  the  air  heated 
by  the  lamp  to  the  space  surrounding  the  patient."  At  the  tempera- 
ture of  85°  air  applied  in  this  way  stimulates  powerfully  the  surface  and 
causes  profuse  perspiration.  It  is  more  certain  in  its  effects  than  either  the 
warm  bath  or  vapor  bath.  From  its  stimulating  character  it  is  peculiarly 
adapted  to  those  cases  in  which  the  skin  is  cold  and  torpid,  and  where  the 
balance  of  the  circulation  is  greatly  disturbed  by  internal  congestions. 

14 


204  MATERIA   MEDIC  A    AND   THERAPEUTICS. 


individual  diaphoretics (internal). 

pulvis  antimonialis  vel   pulvis  jacobi,  the  antimonial   powders 
or  james's  powders. 

This  combination  of  the  oxide  of  antimony  and  the  phosphate  of 
lime  had  at  one  time  great  popularity  as  a  diaphoretic  in  fever.  It  is 
now  rarely  used,  and  might  with  advantage  be  banished  from  the 
Pharmacopoeia.  The  objections  to  it  are  that  it  is  very  uncertain  in  its 
operation,  because  very  variable  in  its  composition. 

Tartar  Emetic. — Of  this  I  have  spoken  under  the  head  of  Emetics 
and  in  the  general  observations  I  made  on  Diaphoretics.  From  the 
general  relaxing  and  depressing  power  of  the  remedy,  it  is  appropriate 
to  cases  where  the  tone  of  the  system  is  above  par — in  such  it  will  often 
do  good. 

It  sometimes  irritates  the  bowels  and  causes  a  troublesome  purging, 
and  the  degree  of  its  prostrating  power  can  never  be  known  beforehand. 
It  must,  therefore,  always  be  watched  closely.     Dose,  one  eighth  grain, 
either  in  solution,  or  combined,  as  proposed  by  Dr.  Brande,  with  chalk, 
in  his  substitute  for  James's  Powders : — 
Ant.  tart.  gr.  viij. 
Pulv.  Gum  arabic, 
Creta  ppt.  aa  3j. — M. 
Sixteen  grains  of  this  powder  contain  one  grain  of  tartar  emetic.     Dose 
— one  to  two  grains. 

AQUA    AOETATIS    AMMONITE    VEL    LIQUOR   ACETATIS    AMMONITE. 

This  is  commonly  known  under  the  name  of  the  Spiritus  Mindereri, 
Mindererus'  Spirit,  under  the  notion  that  he  first  prepared  it.  This  is  a 
mistake  :  it  was  first  made,  in  1732,  by  the  celebrated  Boerhaave.  It  is 
prepared  by  adding  carbonate  of  ammonia,  in  powder,  to  distilled  vine- 
gar, and  stirring  until  effervescence  ceases.  In  this  process  the  acetic 
acid  unites  with  the  ammonia,  while  the  carbonic  acid  escapes.  This 
preparation,  therefore,  consists  of  acetate  of  ammonia  held  in  solution 
by  water.  From  the  variable  strength  of  distilled  vinegar,  it  is  impos- 
sible to  fix  upon  any  definite  quantity  of  the  carbonate  of  ammonia 
which  may  be  necessary  to  saturate  the  acetic  acid.  The  best  mode  of 
ascertaining  it  is  by  testing  the  solution,  during  its  preparation,  by  the 
alternate  use  of  turmeric  and  litmus  paper.  If  perfectly  neutral,  neither 
of  these  will  be  affected.  The  rule,  however,  laid  down,  is  to  let  the 
acid  appear  to  be  slightly  in  excess,  "for  the  carbonic  acid,  which  re- 
mains for  some  time  in  solution,  and  which  seems  to  indicate  excess 
of  acetic  acid,  is  eventually  dissipated  by  time,"  in  which  case,  the  solu- 


DiAPiionimos.  205 

tion  becomes  alkaline  and  somewhat  irritant.  This  is  especially  impor- 
tant in  cases  where  this  preparation  is  used  as  a  collyriimi.  It  is  ob- 
viated by  a  slight  excess  of  acid. 

Properties. — When  pure,  this  preparation  is  limpid  and  colorless  ; 
any  color,  therefore,  which  it  may  possess  is  owing  to  impurities  either 
in  the  ammonia  or  the  vinegar.*  As  commonly  prepared,  it  is  of  a 
brownish  color.  By  filtering,  however,  "through  a  little  well-burned 
and  recently  powdered  charcoal"  it  becomes  perfectly  colorless.f  It  is 
without  smell,  and  has  a  slightly  nauseous  taste.  "  It  should  not  be 
prepared  in  large  quantities,  as  its  acid  becomes  decomposed,  and  a 
portion  of  carbonate  of  ammonia  is  generated.''^ 

According  to  Rennic,  if  either  the  acid  or  alkali  is  in  excess,  it  will 
decompose  the  antimonials,  with  which  it  is  frequently  prescribed. 

Effects. — This  is  a  most  excellent  diaphoretic,  although  spoken  of 
slightingly  by  some,  and  not  very  generally  resorted  to  in  the  practice 
of  the  present  day.  It  acts  on  the  skin  without  producing  any  marked 
effect  on  the  circulation,  either  in  the  way  of  exciting  or  depressing  it. 
Its  action  on  the  stomach  is  that  of  a  mild  stimulant  It  accordingly 
sits  well  upon  that  organ,  and  frequently  answers  an  excellent  purpose 
in  cases  where  a  sudorific  is  required.  Unless  its  operation  be  aided  by 
tepid  drinks,  and  by  keeping  the  surface  covered,  instead  of  acting  on 
the  skin,  it  is  apt  to  run  off  by  the  kidneys.§  [Combined  with  an  equal 
quantity  of  common  soda  water  it  makes  a  very  grateful  febrifuge.] 

The  dose  is  from  3  ss  to  3  j,  repeated  every  two,  or  three,  or  four 
hours.  It  is  frequently  given  in  combination  with  nitre,  antimonials, 
camphor,  and  opium. 

CITRATE    OW    POTASH. 

There  are  two  forms  in  which  this  is  prescribed,  viz.  that  of  the  neu- 
tral saline  mixture  and  the  effervescing  draught. 

The  neutral  mixture  is  prepared  by  saturating  fresh  lemon  juice  with 
the  carbonate  of  potassa.  Of  this  half  an  ounce  diluted  with  an  equal 
quantity  of  water  may  be  given  every  two  or  three  hours. 

The  effervescing  draught  differs  from  the  preceding  only  in  the  mode 
of  administration,  being  taken  in  the  act  of  effervescence.  For  this 
purpose,  take  carbonate  of  potass,  or  soda,   3  ii,  aqua  font.   3  iij. 

To  a  tablespoonful  of  this  solution  add  a  tablespoonful  of  lemon  juice, 
previously  diluted  with  the  same  quantity  of  water,  and  drink  in  the  act 
of  effervescence. 

Effects. — This  is  analogous  to  the  spiritus  mindereri,  as  a  diaphoretic  ; 

*  Pereira,  v.  L  p.  183.  $  U.  S.  Disp.  p.  756. 

f  Braade,  p.  217.  §  Alexander,  p.  154. 


206  MATERIA   MEDICA  AND   THERAPEUTICS. 

arid  in  addition  to  this,  is  refrigerant  and  gratefully  stimulant  to  the 
stomach.  No  remedy  is  better  calculated  to  allay  nausea  and  irrita- 
bility of  the  stomach  in  fever. 

[The  antifebrile  effect  of  effervescing  draughts  is,  I  think,  increased  if 
the  alkali  be  in  excess.  I  use  tartaric  acid  and  carb.  soda,  and  in  the 
proportions  of  one  part  of  the  former  to  two  of  the  latter,  e.  g.  tartaric 
acid,  3  i ;  dissolved  in  water,  3  viij  ;  bi-carb.  soda?,  3  ii ;  dissolve  in 
water,    §  viij. — Ed.] 


Dover's  powder  (Pulvis  Ipecacuanhce  compositus.  JPulvis  Ipecacuanha 
et  Opii,  Pulveris  Doveri). 

Made  by  rubbing  up  hard  opium,  3  i  /  powdered  ipecac.  3  i ;  with 
sulp>h  potassw,  3  i.  This  is  one  of  the  most  valuable  and  efficient 
sudorifics  we  possess,  and  furnishes  a  beautiful  illustration  of  the  effects 
and  advantages  of  combining  medicines  together.  Opium  and  ipecac, 
both  determine  to  the  skin,  but  neither  of  them  in  the  way  that  the 
compound  does.  The  potash  is  generally  supposed  merely  to  aid  in  the 
trituration  of  the  opium.  It  would  seem,  however,  to  aid  also  in  modi- 
fying the  general  effect  of  the  combination,  inasmuch  as  the  opium  and 
the  ipecac,  alone  do  not  produce  the  same  effects.  From  the  nature  of 
its  ingredients,  this  powder  is  peculiar  in  its  operation,  and  requires  to 
be  given  with  certain  restrictions.  Opium,  while  it  acts  on  the  skin, 
shuts  up  the  other  secretions,  and  is  stimulant  to  the  brain.  It  cannot, 
therefore,  be  given  where  vascular  action  runs  very  high,  where  the 
tongue  is  dry,  where  the  bowels  are  costive,  and  where  the  brain  is  dis- 
ordered. Again,  ipecac,  affects  the  stomach  ;  and  in  consequence  of 
this,  Dover's  powder  is  improper  when  the  stomach  is  irritable.  On 
the  other  hand,  where  vascular  action  is  moderate,  or  has  been  properly 
subdued  by  venesection,  where  the  tongue  is  moist,  the  bowels  free,  the 
head  undisturbed,  and  the  stomach  not  irritable,  it  may  be  used  with 
safety.  In  all  cases  where  the  object  is  to  quiet  irritation  and  pain,  and 
at  the  same  time  act  on  the  skin,  it  is  an  admirable  article,  as  in  dysen- 
tery, chronic  rheumatism,  &c.     Dose  from  5  to  10  grs.  . 


EUPAT0RIUM    PERFOLIATUM. 

Known  by  the  common  names  of  boneset,  Indian  sage,  thorough-wort^ 
cross-wort,  vegetable  antimony.  It  is  a  plant  indigenous  to  every  part  of 
this  country,  growing  from  two  to  five  feet  high,  flowers  from  July 
to  October,  and  is  found  in  meadows  and  near  the  banks  of  streams. 
Although  every  part  of  the  plant  is  active,  yet  the  leaves  and  flower 


DIAPHOEBTIOS.  207 

are  the  most  so.  Those,  therefore,  are  used  with  the  sterns  in  the  form 
of  the  herb.  As  found  in  the  market,  it  is  in  bundles  prepared  by  the 
Shakers.     Boneset  has  a  faint  odor,  but  an   intensely  bitter  taste  ;   no 

satisfactory  analysis  of  it  is  yet  made.  It  yields  its  virtues  both  to  alco" 
hoi  and  water. 

The  effects  of  this  article  differ  very  much  according  to  the  manner  of 
using  it.  In  moderate  doses,  and  in  the  form  of  powder  or  cold  infusion, 
it  is  tonic.  In  larger  quantities,  and  in  warm  infusion,  it  sometimes 
proves  emetic  and  laxative,  but  more  commonly  acts  as  a  sudorific.  It 
is  owing  to  its  decided  action  on  the  skin  that  it  has  received  one  of  its 
names,  "  vegetable  antimony."  Boneset,  therefore,  may  be  considered  as 
a  tonic  sudorific,  and  as  such  has  been  used  with  much  success  in  fevers, 
typhoid  pneumonia,  and  rheumatism.  The  name  boneset  is  said  to  be 
derived  from  its  success  in  a  rheumatic  fever  which  prevailed  in  New 
England,  and  was  called  "break-bone fever P 

Forms. — As  a  tonic  in  powder,  20  to  30  grs. ;  or  cold  infusion  (  3  i  to 
lb.  i  boiling  water)  ;  3  i  3  or  4  times  a  day;  as  &  diaphoretic,  warm  infu- 
sion in  larger  quantitieTand  oftener  repeated. 


ASCLEPIAS    TUBEROSA. 

Known  by  the  common  names  of  pleurisy  root,  butterfly  weed,  decum- 
bent swallow-wort.  A  plant  two  or  three  feet  high,  indigenous  in  every 
part  of  the  United  States,  but  most  abundant  at  the  South.  The  root 
is  perennial  and  sends  up  a  number  of  stems,  some  erect,  others  decum- 
bent ;  differs  from  the  other  species  of  asclepias  in  not  giving  out  a 
milky  juice  when  wounded.  The  part  used  is  the  root,  which  is  large 
and  tuberose,  externally  brown,  internally  white  and  striated;  when 
fresh  has  a  nauseous  sub-acrid  taste ;  when  dried,  bitter,  but  not  unplea- 
sant. Powder,  dirty  white.  According  to  Bigelow,  its  most  abundant 
soluble  portions  are  bitter  extractive  and  fecula.  It  yields  its  virtues  to 
boiling  water. 

In  suitable  doses  it  acts  as  a  sudorific  and  expectorant,  without  increas- 
ing animal  heat  or  exciting  the  circulation.  On  the  stomach  it  proves 
slightly  tonic  If  in  large  quantities  it  proves  laxative.  The  general 
effect  of  this  article  is  to  promote  the  secretions  of  the  mucous  mem- 
brane of  the  stomach,  bowreIs  and  lungs,  and  of  the  skin,  without  any 
marked  effect  on  the  circulation.  It  has  been  used  with  advantage  in 
pulmonary  complaints  along  with  suitable  depletion.  Hence  its  name, 
pleurisy  root.     Also  in  rheumatism. 

Forms. — Powder  20  to  30  grs.  several  times  a  day.  Best  form  is 
decoction,  when  used  as  sudorific.    Boiling   5  j  in  quart  of  water —  3  ij 


208  MATERIA  MEDICA   AND   THERAPEUTICS. 

every  two  hours.     For  children   3  ij  boiled  in  pint  of  milk —  3  j  two  or 
three  times  a  day.     In  this  way  proves  diaphoretic  and  laxative. 


ARISTOLOCHIA    SERPENTARIA. 

This  is  a  small  plant  about  eight  or  ten  inches  high,  growing  in  the 
woods  in  the  Middle,  Southern,  and  Western  States.  The  part  used  in 
medicine  is  the  root,  which  is  perennial,  and  consists  of  a  number  of 
slender  fibres  shooting  from  a  horizontal  caudex.  When  fresh  the  color 
of  the  fibre  is  yellow  ;  by  keeping  it  becomes  brown.  The  powder  is 
of  a  grey  color.  Its  smell  is  strong,,  aromatic,,  and  camphorous.  It  has 
a  warm  and  bitter  taste. 

By  analysis  this  root  is  found  to  contain  a  volatile  oilr  a  yellowish  bit- 
ter  principle,  resin,  gum,  lignin,  and  various  salts.- 

Its  virtues  are  extracted  both  by  water  and  alcohol. 

JEffects. — A  stimulant,  aromatic  diaphoretic,  admirably  adapted  to 
those  forms  and  stages  of  fever  which  are  characterized  by  debility. 
Generally  used  as  an  infusion.  3"  ss-of  the  root  to  one  pint  of  boiling 
water ;  macerate  for  a  couple  of  hours  and  then  strain  \  of  this  one  or 
two  ounces  every  couple  of  hours- in  fever.  -•''"     '  *   v 


EXPECTORANTS 


Expectorants  arc  defined  to  be  those  medicines  which  facilitateor 
promote  the  rejection  of  mucus  or  other  fluids  from  the  lungs  and 
trachea. 

There  is,  perhaps,  no  class  of  agents  which  is  so  much  used  and  so 
much  abused  as  this.  They  are  resorted  to  on  all  occasions  of  cough, 
without  any  precise  notions  as  to  the  mode  of  their  operation  or  the 
actual  effects  which  they  produce.  Hence  it  is,  that  in  the  ordinary 
course  of  practice,  they  do  a  great  deal  more  harm  than  good.  It  be- 
comes important,  therefore,  that  they  should  be  made  the  subject  of 
special  investigation,  and  with  this  view,  let  us  look  at  the  nature  of  the 
parts  upon  which  they  act,  and  the  causes  which  give  rise  to  difficult  or 
deficient  expectoration. 

The  whole  of  the  air  passages  are  lined  with  mucous  membrane.  This 
secretes  mucus,  a  certain  amount  of  which  is  necessary  to  keep  the  mem- 
brane in  a  state  to  perform  its  function,  not,  for  the  present,  to  speak  of 
its  importance  as  an  excretion.  When  this  secretion  is  in  due  propor- 
tion respiration  is  performed,  so  far  at  least  as  this  part  is  concerned, 
naturally  and  easily.  There  is  neither  cough  nor  irritation.  It  hap- 
pens, however,  from  various  causes,  that  this  organ  becomes  disordered, 
and  one  of  the  first  and  most  striking  of  the  effects  is  a  change  in  the 
quantity  as  well  as  quality  of  its  secretion.  Now,  the  disorder  of  the 
mucous  membrane  is  of  different  characters  in  different  cases,  conse- 
quently the  effect  as  to  the  state  of  its  secretion  differs  very  much.  In 
some  the  membrane  becomes  inflamed  or  constricted,  and  then  the  quan- 
tity of  secretion  is  greatly  lessened.  Now,  the  consequence  of  this  is, 
that  when  the  air  in  respiration  passes  over  this  dry  membrane  it  causes 
irritation  and  produces  cough,  which  is  nothing  more  than  an  effort  to 
get  rid  of  some  irritating  cause.  In  other  cases  the  membrane  may  be 
so  disordered  as  to  give  rise  to  an  increase  of  secretion.  The  effect  of 
this  will  be,  of  course,  partially  to  obstruct  the  tubes  and  cells  through 
which  the  air  passes  in  respiration,  and  this  will  give  rise  to  cough. 

In  other  cases,  again,  the  membrane  may  be  so  disordered  as  to  pro- 
duce a  viscid,  tenacious  secretion,  which  may  adhere  to  it,  and  in  this 
way  keep  up  a  constant  irritation.  Now,  in  all  these  cases  you  per- 
ceive the  real  and  primary  seat  of  all  the  difficulty  is  in  the  condition 


210  MATERIA  MEDIC  A  AND   THERAPEUTICS. 

of  the  mucous  membrane  of  the  respiratory  organs,  and  the  change 
which  follows  in  the  character  and  quantity  of  its  secretions. 

In  the  treatment,  the  great  object  is,  or  ought  to  be,  to  effect  such  a 
change  in  this  disordered  membrane,  as  will  restore  its  secretions  to 
their  natural  quantity  and  quality.  Now,  it  is  very  evident  that  this 
must  not  be  effected  by  any  one  set  of  remedies,  they  must  be  adapted 
to  the  particular  character  of  the  disorder.  Among  these,  what  are 
commonly  called  expectorants  are  of  the  least  importance.  Still,  how- 
ever, they  may  be  rendered  very  valuable  and  useful  if  properly  ap- 
plied. 

In  addition  to  the  disordered  state  of  the  mucous  membrane,  there 
are  other  conditions  of  the  respiratory  organs  which  require  to  be 
noticed,  and  which  give  rise  to  the  same  difficulty.  Morbid  matter 
may  be  found  in  consequence  of  ulceration,  the  presence  of  softened 
tuberculous  matter,  or  of  pus,  as  in  abscess.  Now,  in  all  these  cases, 
expectoration  may  require  to  be  assisted.  Again,  the  bronchial  tubes 
may  be  the  seat  of  spasmodic  stricture,  interfering  at  once  with  respira- 
tion and  secretion. 

The  prominent  symptom  which  indicates  each  of  these  morbid 
conditions  is  cough,  and  the  great  error  in  the  use  of  expectorants  is, 
that  everything  is  generally  directed  to  suppress  this  symptom,  and  this, 
not  by  removing  the  cause  of  the  cough,  but  by  giving  anodynes.  These 
simply  lull  the  cough,  but  do  not  change  the  condition  of  the  parts — 
nay,  sometimes  make  it  materially  worse,  and  that  in  two  several  ways. 

1.  They  check  secretion.  Now,  secretion  is  nature's  mode  of  reliev- 
ing overloaded  vessels.  This  relief  may  be  essential  to  the  removal  of 
the  disease  ;  opiates  render  it  unattainable. 

2.  They  suppress  cough.  Here,  again,  cough  is  nature's  effort  to  re- 
move something  out  of  the  larynx,  trachea,  or  bronchi.  Suppress  this 
effort,  and  the  cause  of  irritation  will  remain  to  aggravate  the  present 
disease,  or  perhaps  to  cause  another  and  more  serious  one. 

Cough  is  a  forcible  expiration ;  and,  while  it  is  ordinarily  an  index  of 
something  wrong,  some  cause  of  irritation  in  the  lungs,  is  an  effort  of 
nature  to  get  rid  of  this  offending  cause.  It  is  a  natural,  and  often  a 
very  salutary  process.  But,  like  other  similar  natural  efforts,  it  may  be 
excessive  or  irregular,  and  then  it  may  irritate  and  exhaust  the  system. 
Under  such  circumstances  it  may  be  proper  to  modify  or  control  the 
action  of  this  agent,  so  as  to  secure  all  its  good  without  any  of  its  evil 
consequences.  But  this  is  to  be  done  by  removing  the  cause  of  cough, 
if  that  be  possible,  not  by  suppressing  it  with  opium,  as  is  too  much  the 
habit  of  some.  All  that  opium  can  do  under  such  circumstances  is  by 
diminishing  the  sensibility  to  check  the  efforts  of  nature  to  rid  herself  of 
the  irritating  cause.  To  show  how  absurd  this  opium  practice  is,  ima- 
gine that  the  cough  were  excited  by  a  bean  or  other  physical  irritant  in 


EXPECTORANTS.  211 

the  trachea.    Who  would  think  of  giving  opium?     Let  this  analogy 

guide  your  practice:  Get  rid  of  the  bean — remove  the  cause  and  the 
effect  will  cease.  To  do  this  it,  is,  of  course,  essential  that  wre  investi- 
gate the  case,  and  ascertain,  if  possible,  the  cause  of  cough.  Now  cough 
may  arise  from  disordered  conditions  of  the  fauces,  especially  elongation 
of  the  uvula,  from  morbid  states  of  the  larynx,  or  of  the  mucous  mem- 
brane lining  the  bronchial  tubes,  or  of  the  lungs,  or  the  pleural  mem- 
brane, from  effusions  into  the  cavity  of  the  chest,  diseases  of  the  heart, 
or  sympathetically  from  disorder  of  the  stomach,  liver,  <kc. 

It  must  be  self-evident  that  it  is  only  in  certain  of  these  cases  that 
pure  expectorants  are  applicable.  The  proper  mode  of  treatment  is  to 
address  your  remedies  to  the  cause  of  the  cough  ;  and  it  is  only  in  this 
way  that  you  can  safely  remove  it.  If  you  suppress  it  merely  by  opiate 
expectorants,  you  frequently  aggravate  the  original  difficulty,  and  the 
relief  is  only  temporary. 

The  cases  where  expectorants  are  salutary,  are  principally  those  in 
which  the  mucous  membrane  of  the  lungs  is  disordered. 

What  I  wish  is,  that  you  should  have  correct  notions  of  the  nature 
of  cough,  and  not  look  upon  it  as  a  thing  to  be  put  down  by  specific 
remedies.  It  is  merely  a  symptom  of  disease,  and  not  the  disease  itself. 
Do  not,  therefore,  be  in  a  hurry  to  suppress  it  at  once. 


PRACTICAL    APPLICATIONS. 

The  only  diseases  in  which  expectorants  can  be  used  are  those  of  the 
air  passages.     Each  of  these  I  shall  briefly  notice. 

1.  Laryngitis. — From  the  violence  of  this  affection,  and  the  rapidity 
with  which  it  runs  its  course,  nothing  is  to  be  expected  from  simple 
expectorants.  Active  remedies  may  be  beneficial,  and  of  these  I  have 
already  spoken. 

2.  Trachitis. — This  is  an  inflammation  of  the  mucous  membrane  lin- 
ing the  trachea.  An  analysis  of  the  different  stages  through  which  this 
affection  passes  will  show  how  far  expectorant  agents  may  be  rendered 
available.  For  practical  purposes  croup  may  be  divided  into  three 
stages.  In  the  first  or  forming  stage,  the  disease  is  purely  local,  and 
consists  essentially  in  a  strictured  condition  of  the  extreme  vessels  of  the 
mucous  membrane  of  the  trachea.  In  this  stage,  by  the  prompt 
administration  of  relaxing  emetics,  such  as  tartar  emetic  and  ipecacu- 
anha, it  may  be  completely  broken  up.  By  the  peculiar  operation  of 
these  agents,  the  stricture  is  relieved,  the  secretions  of  the  part  restored, 
and  general  relaxation  of  the  system  induced.  In  the  second  or  inflam- 
matory stage,  the  disease  becomes  changed  from  a  purely  local  one ; 
active  inflammation  of  the  part  now  exists,  accompanied  by  general  in- 


212  MATERIA   MEDICA   AND   THEKAPEUTICS. 

flammatory  excitement.  In  this  condition  of  things  it  becomes  neces- 
sary to  resort  to  the  use  of  the  most  potent  antiphlogistic  remedies,  and 
among  these  venesection,  tartar  emetic,  and  calomel  are  the  most  pro- 
minent agents. 

In  the  third  or  last  stage,  the  general  excitement  subsides,  and  the 
local  inflammation  terminates  in  an  effusion  of  coagulable  lymph,  consti- 
tuting the  false  membrane  which  lines  the  inner  surface  of  the  trachea. 
In  this  stage  the  object  is  to  separate  and  cause  to  be  thrown  off,  if 
possible,  this  membrane.  As  at  this  time  the  strength  is  very  much 
impaired,  and  in  fact  a  collapse  of  the  system  has  ensued,  a  class  of 
medicines  are  to  be  used  entirely  different  from  those  which  are  proper 
in  the  other  stages.  All  debilitating  remedies  are  now  of  course 
improper  and  injurious ;  on  the  contrary  such  articles  are  now  to  be 
resorted  to  as  while  they  do  not  impair  the  general  strength,  have  the 
effect  of  promoting  the  secretions  from  the  trachea,  and  of  facilitating 
the  rejection  of  whatever  matters  may  be  accumulated.  For  this  pur- 
pose the  vitriolic  emetics  are  found  useful,  but  more  especially  the  poly- 
gala  senega.  This  keeps  up  a  local  stimulant  action  upon  the  trachea, 
followed  by  copious  secretion,  and  frequently  produces  the  most  bene- 
ficial consequences.  By  Dr.  Archer  the  use  of  the  snake  root  is  recom- 
mended in  all  stages  of  the  complaint,  and  in  many  cases,  provided 
venesection  be  properly  premised,  and  tartar  emetic  be  duly  exhibited 
to  keep  down  excitement,  it  may  be  advantageously  prescribed.  The 
Hive  syrup  of  Dr.  Coxe  is  an  excellent  combination  for  obtaining  the 
peculiar  and  specific  effects  of  the  senega  without  the  danger  resulting 
from  its  stimulant  operation. 

3.  Bronchitis. — This  is  of  two  kinds,  the  acute  and  the  chronic. 

Acute  Bronchitis. — In  this  form  of  it  all  agents  calculated  to  produce 
a  relaxing  effect  upon  the  inflamed  membrane  and  promote  the  secretions 
from  it  may  have  a  salutary  influence.  With  this  view  tartar  emetic 
may  be  used  with  great  freedom,  and  it  will  be  found  to  act  beneficially 
not  merely  by  its  relaxing  effect  on  the  inflamed  membrane,  but  by  its 
general  antiphlogistic  operation  on  the  system  at  large.  Ipecacuanha 
may  be  used  also  with  the  same  view.  The  inhalation  of  warm  aqueous 
vapor  will  be  found  useful.  In  short,  whatever  has  a  tendency  to 
relax  the  inflamed  surface,  promote  secretion  from  it,  and  at  the  same 
time  lessen  general  excitement,  may  be  used  as  an  expectorant.  Either 
of  these  emetic  substances  may  be  pushed  to  free  vomiting  with  great 
advantage.,  In  children,  in  whom  expectoration  is  always  a  difficult 
process,  they  are  remedies  of  great  importance.  Vomiting  unloads  the 
bronchial  tubes  of  collections  of  mucus,  and  thus  relieves  the  lungs,  while 
it  lessens  excitement  and  determines  to  the  surface.  For  adults,  tartar 
emetic  is  the  best ;  for  children,  ipecacuanha.  With  the  exception  of 
the  articles  just  mentioned,  expectorants  are  remedies  not  merely  of 


EXPECTORANTS.  2 1  3 

doubtful  efficacy,  but  productive  of  mischievous  consequences.  Espe- 
cially all  such  as  produce  a  stimulating  effect  are  improper.  On  this 
account,  squills,  ammoniac,  and  all  others  of  an  analogous  character,  are 
altogether  out  of  the  question  whenever  fever  or  general  excitement,  is 
present.  The  idea  on  which  they  are  generally  used  is  that  the  expec- 
toration is  a  salutary  discharge  calculated  to  relieve  the  disease,  and 
therefore  ought  to  be  encouraged.  Now,  this  is  true  only  to  a  certain 
extent.  The  matter  expectorated  is  nothing  more  than  the  result  of  the 
inflammatory  action  in  the  mucous  membrane,  and  to  encourage  the 
increase  of  this  to  the  extent  proposed  by  some,  would  be  about  as 
sensible  as  to  encourage  the  morbid  discharges  in  dysentery  with  the 
idea  of  relieving  that  difease.  The  principle,  therefore,  on  which  stimu- 
lating expectorants  are  used,  is  erroneous.  They  may  increase  the 
expectoration,  but  they  do  so  by  increasing  the  diseased  condition  of  the 
part  on  which  expectoration  depends.  All  that  you  want  to  accomplish 
by  expectorants  in  these  cases  is  simply  to  aid  in  throwing  off  what  is 
actually  secreted  by  the  diseased  membrane,  and  to  restore  as  far  as 
possible  the  natural  healthy  secretions  of  the  part.  Anything  going 
beyond  this  must  be  injurious. 

Chronic  Bronchitis. — In  this  form  of  the  disease  expectorants  of 
various  kinds  are  remedies  almost  universally  resorted  to.  Let  us  see 
upon  what  principles.  In  this  disease  there  is  a  chronic  inflammation 
of  the  mucous  membrane  accompanied  with  excessive  determination  of 
fluid  to  the  part,  and  a  consequent  excessive  secretion  from  it.  This  is 
the  simple  condition  of  the  parts.  Now  so  far  as  expectorants  aid  in 
throwing  off  matter  already  secreted  into  the  bronchial  cells,  and  so  far 
as  they  have  ai  tendency  to  alter  the  condition  of  the  mucous  membrane 
which  keeps  up  this  secretion,  so  far  they  may  be  beneficial.  When, 
however,  they  go  beyond  this,  when  they  stimulate  the  mucous  mem- 
brane so  as  to  increase  the  secretions,  they  necessarily  do  harm.  By 
the  determination  which  they  keep  up  to  the  part  they  continue  the 
morbid  condition  of  the  mucous  membrane  upon  which  the  whole 
difficulty  depends.  Here  it  is  that  such  articles  as  squills  which  are  in 
such  common  use  frequently  do  more  harm  than  good. 

As  occasional  remedies  to  unload  the  lungs,  emetics  are  remedies  of 
great  value;  Ipecacuanha  and  in  some  cases  the  sulphate  of  zinc 
answer  the  best  purpose.. 

Inhalations  of  various  substances  may  be  used  with  considerable 
advantage  in  this  form  of  disease.  Vapors  of  tar,  the  balsa??is,  iodine, 
and  chlorine  have  all  proved  more  or  less  beneficial..  A  good  deal  of 
the  success  attending  these  remedies  must  necessarily  depend  upon  the 
way  in  which  they  are  used.  Much  harm  has  been  done,  for  instance, 
by  inhaling  them  when  not  sufficiently  diluted  with  atmospheric  air. 


214  MATERIA   MEDICA   AND   THERAPEUTICS. 

When  this  is  the  case,  it  is  very  evident  that  they  may  prove  injurious 
by  acting  as  mere  irritants. 

4.  Pneumonia. — This  is  an  inflammation  of  the  substance  of  the 
lungs,  and  is  to  be  treated  by  the  most  active  remedies.  Among  these, 
venesection,  calomel,  and  tartar  emetic  hold  a  prominent  place.  By 
resolving  this  inflammation,  these  promote  expectoration,  in  the  only 
■way  in  which  it  ought  to  be  promoted. 

The  heroic  treatment  here  recommended  in  pneumonia  has  given 
place  among  us  to  a  much  milder  course.  Venesection  is  almost  never 
employed,  and  calomel  rarely. 

5.  Asthma. — Various  opinions  are  entertained  in  relation  to  the 
proximate  cause  of  this  disease.  It  comes  on  in  paroxysms,  and  the 
treatment  of  it  is  to  be  divided  into  that  which  is  proper  during 
the  paroxysm,  and  that  during  the  intermission.  Now  it  is  mainly 
during  the  paroxysm  that  the  agents  belonging  to  this  class  are  found 
useful.  Emetics  have  already  been  spoken  of  under  that  head.  They 
are  prompt  and  efficacious  remedies  both  to  relieve  spasm  and  remove 
accumulations  of  mucus.  Among  these,  ipecacuanha  is  the  best — in 
some  cases,  tartar  emetic.  Expectorants,  though  generally  prescribed, 
are  proper  only  in  certain  cases.  In  relaxed  habits,  where  the  pulse  is 
low  and  feeble,  and  no  excitement  present,  squills,  ammoniac,  &c,  may 
be  useful.  Wherever  inflammatory  action  is  present,  these  articles 
must  do  harm.  The  smoking  of  tobacco  and  stramonium  frequently 
proves  beneficial,  as  does  also  the  inhalation  of  relaxing  and  narcotic 
vapors. 

MODES    IN    WHICH    EXPECTORANTS    PROVE    CURATIVE. 

Expectorants  prove  curative  by  preparing  the  matter  to  be  brought 
up  by  coughing.  The  way  in  which  they  do  this  must  of  course  vary 
according  to  the  condition  of  the  lungs,  by  promoting  secretion  where  the 
secretion  is  deficient,  or  diminishing  secretion  where  it  is  excessive. 

As  in  these  cases  the  state  of  the  mucous  membrane  of  the  lungs 
must  differ  very  materially,  the  great  art  in  the  use  of  expectorants  is  to 
select  such  as  are  appropriate  to  the  case.  Some  are  relaxing — some 
stimulating. 

VARIOUS     MODES     IN    WHICH    EXPECTORANTS     MAY    BE     MADE    TO    AFFECT 

THE    SYSTEM. 

By  inhalation  in  the  form  of  vapor.  This  is  the  most  direct  way  in 
which  expectorants  can  be  introduced.  They  come  in  immediate  con- 
tact with  the  disordered  structure,  and  produce  their  effects  by  the 
changes  which  they  thus  occasion  in  it. 


KXIUCCTO  liA  NTS.  ll  1  .", 

By  being  slowly  dissolved  in  the  mouth,  and  making  a  certain 
impression  on  the  fauces,  whieli  is  sympathetically  transmitted  down 
the  mucous  membrane  of  the  trachea  and  bronchi  se.  This  is  the  way 
in  which  the  salutary  effect  of  liquorice  and  other  demulcent  substances 
is  to  be  explained. 

By  being  taken  into  the  stomach  and  absorbed,  they  affect  the  mucous 
lining  of  the  lungs.  This  they  may  do  either  by  direct  action,  subse- 
quent to  their  absorption,  or  by  affecting  the  mucous  membrane  through 
the  general  system. 

Rules  to  be  observed  during  the  Administration. 

Determine  as  distinctly  as  possible  what  the  actual  condition  of  the 
pulmonary  organ  is,  and  what  your  precise  object  is  in  prescribing  the 
remedy. 

Having  determined  what  the  precise  condition  of  the  mucous  lining 
of  the  lungs  is,  a  proper  selection  of  the  appropriate  article  must  be 
made.  To  do  this  requires,  of  course,  an  accurate  knowledge  of  the 
distinctive  properties  of  these  articles.  An  error  in  this  respect  may  be 
attended  with  very  unpleasant  circumstances. 

During  the  use  of  expectorants,  keep  up  a  due  degree  of  warmth  on 
the  surface.  From  the  sympathy  existing  between  the  lungs  and  the 
skin,  it  is  well  known  that  the  former  are  very  much  relieved  by  keep- 
ing up  a  determination  to  the  latter,  and  expectoration  is  generally 
more  free  when  the  surface  is  relaxed  ;  all  determination  to  the  urinary 
organs  should  be  avoided,  and  as  a  general  rule  avoid  purging  during 
the  use  of  expectorants.  This,  however,  must  be  taken  with  certain 
restrictions.  As  the  impression  they  make  is  only  temporary,  they 
should  be  repeated  at  short  intervals.  A  free  use  of  warm  diluents  aids 
their  effects. 


INDIVIDUAL    EXPECTOEANTS. 

RELAXING    SUBSTANCES. 

1.  Vapor  of  Hot  Water. — This  is  the  simplest  and  perhaps  most 
efficacious  of  all  the  articles  that  can  be  used  in  the  way  of  inhalation. 
A  common  and  very  good  way  of  doing  this  is  simply  to  inhale  the 
steam  from  a  jar  or  pitcher. 

A  more  perfect  contrivance  is  the  inhaler  originally  constructed  by 
Mudge. 

Effects. — The  effects  of  this  application  are  obvious.  It  relaxes  the 
extremities  of  the  vessels  of  the  mucous  membrane — causing  them  to 
secrete  freely — and  in  this  way  resolving  stricture  and  inflammation. 


216  MATERIA    MEDICA   AND    THERAPEUTICS. 

By  Mudge  this  remedy  was  originally  recommended  in  combination 
with  opium,  in  cases  of  incipient  catarrh,  and  by  him  was  used  with  great 
success.  It  is  certainly  rendered  more  efficacious  by  throwing  an  ounee 
of  paregoric  into  the  water. 

Ipecacuanha. — Of  this  article  I  have  already  spoken  very  fully  under 
the  head  of  emetics,  and  I  have  shown  that  it  produces  a  similar  effect 
on  the  mucous  membrane,  not  merely  of  the  stomach,  but  of  the  fauces 
and  bronchial  tubes — promoting  secretion  and  relaxation  of  this 
membrane. 

It  is  in  consequence  of  these  properties  that  it  is  used  as  an  expecto- 
rant and  proves  so  very  valuable.  It  may  be  given  alone  simply  mixed 
in  water,  in  doses  of  grs.  j  or  ij — repeated  according  to  circumstances — 
or  made  up  into  pills  of  gr.  j  each  with  soap,  to  be  repeated  two  or 
three  times  a  day.  The  more  common  mode,  however,  of  using  this 
article  is  in  the  form  of  syrup  of  ipecac,  in  combination  with  demulcent 
and  other  articles. 

Tartar  Emetic. — Of  all  the  articles  belonging  to  the  class  of  relaxing 
expectorants,  this  is  the  most  effective.  It  controls  the  circulation — 
acts  upon  the  extreme  vessels  of  the  system  at  large — promotes  secre- 
tion and  exhalation,  and  in  all  these  various  ways  proves  beneficial  as 
an  expectorant.  Indeed  it  forms  the  efficient  basis  of  most  of  the  mix- 
tures of  this  kind  that  are  used.  As  an  expectorant  it  is  to  be  given  in 
minute  doses  of  -i-  or  less  of  a  grain,  frequently  repeated.  During  its 
use  it  is  exceedingly  important  that  the  body  should  be  kept  warm.  [It 
is  much  less  used  than  formerly.] 

Demulcents. — A  great  variety  of  these  are  used  with  great  advantage 
for  allaying  pulmonary  irritation  and  producing  relaxation  of  its  vessels. 
Liquorice,  gum  arabic,  &c,  are  among  the  best.  They  enter  largely 
into  the  composition  of  expectorant  mixtures. 

Inhalations. —  Chlorhw. — The  properties  of  this  substance  you  are  all 
acquainted  with.  Its  uses  in  a  medical  point  of  view7,  though  limited,  are 
exceedingly  important.  As  a  disinfecting  agent  it  has  long  been  celebrated. 
It  has  had  considerable  repute  as  a  remedy  in  cases  of  pulmonary 
consumption,  and  the  mode  of  using  it  is  that  of  inhalation  or  breathing 
an  atmosphere  impregnated  with  it.  The  way  in  which  it  first  attracted 
attention  as  a  remedy  in  consumption  was  by  the  fact  having  been 
observed  that  those  employed  in  manufactories  where  chlorine  is  freely 
extracted  (as  in  bleaching  establishments,  &c.)  were  greatly  relieved 
and  even  cured  of  pulmonary  affections  under  which  they  had  been 
previously  laboring. 

Effects. — When  cautiously  and  gradually  inhaled  the  evident  effects 
are  a  slight  sensation  of  constriction  in  the  thorax,  with  some  increase 
of  cough ;  in  a  few  instances  a  trifling  degree  of  vertigo  has  been  expe- 
rienced, but  these  feelings  rapidly  subside ;  expectoration  is  produced 


EXI'KCTOKA  NTS.  o  j  7 

almost  without  an  effort,  and  the  patient  gradually  becomes  more  com- 
fortable than  before  inhaling  the  gas. 

If  used  without  dilution,  the  chlorine  produces  irritating  effects  upon 
the  lungs.  Tliey  are,  however,  only  temporary,  soon  pass  off,  and  leave 
no  bad  effects  behind.  In  the  manufactories  large  quantities  are  con- 
stantly inhaled  without  any  evil  consequences. 

Balsam  of  Tola. — By  pouring  a  pint  of  boiling  water  upon  one  ounce 
of  balsam  of  Tolu,  a  good  stimulating  inhalation  may  be  formed  which 
may  be  advantageously  used  in  debilitated  states  of  the  lungs,  or  when 
they  are  overloaded  with  viscid  mucous  accumulations.  It  may  be 
inhaled  through  Mudge's  inhaler,  or  from  ajar  or  pitcher. 

3.  Iodine. — This  is  a  remedy  from  which  much  was  at  one  time  ex- 
pected, but  it  is  now  very  little  used. 

4.  Tar. — Tar  is  a  well  known  substance,  and  its  inhalation  in  the 
form  of  vapor  has  gained  no  little  celebrity  in  certain  diseases  of  the 
pulmonary  organs.  The  best  mode  of  using  this,  is  to  put  a  pint  of  tar 
into  a  proper  dish  in  a  room  of  some  size,  a  spirit  lamp  is  then  placed 
under  it,  and  in  a  very  short  time  the  whole  atmosphere  of  the  apart- 
ment will  be  charged  with  the  vapor.  This  remedy  is  now  very  little 
used.     In  some  chronic  irritations  of  the  lungs  it  may  do  o"ood. 


POLYGALA    SENEGA. 

This  is  commonly  known  by  the  name  of  the  Senega  Snakeroot.  It 
is  a  native  of  this  country,  and  grows  wild  in  every  part  of  the  United 
States,  but  more  especially  in  the  southern  and  western  states.  It  con- 
sists of  several  slender  erect  stems,  sent  up  from  a  single  root,  which  is 
perennial.  It  grows  to  the  height  of  about  a  foot,  and  flowers  from 
June  to  August.     The  part  used  in  medicine  is  the  root. 

Physical  Characters  of  the  Root. — The  dried  root,  as  found  in  the 
shops,  varies  in  size  from  a  common  quill  to  that  of  the  little  finder.  It  is 
very  much  twisted,  filled  with  hard  eminences,  and  terminating  in  a  knotty 
head.  There  is  a  peculiar  projecting  line  extending  from  one  extremity 
of  the  root  to  the  other.  The  cortical  part  is  thick,  hard,  and  resinous. 
and  of  a  grey  color.  It  is  in  this  that  all  the  active  properties  reside. 
The  internal  part  is  ligneous,  white,  and  inert.  The  odor,  though 
strong  in  the  fresh  root,  is  very  faint  in  the  dried  ;  its  taste  at  first 
sweetish,  and  somewhat  mucilaginous,  becomes,  after  beino-  chewed  a  few 
seconds,  pungent  and  acrid,  producing  a  degree  of  irritation  about  the 
fauces,  and  a  tendency  to  cough  and  salivation.  The  powder  is  of  a 
grey  color. 

The  virtues  of  the  root  are  extracted  by  boiling  water,  and  by  diluted 
alcohol. 


218  MATERIA   MEDICA  AND   THERAPEUTICS. 

Effects. — The  first  effect  produced  by  this  article  is  a  peculiar  sensa- 
tion in  the  fauces  and  oesophagus,  which  is  compared  to  that  of  burning. 
This  comes  on  a  few  minutes  after  it  is  swallowed,  and  followed  by  a 
considerable  secretion  and  a  discharge,  by  hawking  of  mucus  from  the 
fauces  and  trachea.*  From  an  ordinary  dose  these  sensations  continue 
one  or  two  hours.  To  this  succeeds  nausea,  and  sometimes  actual 
vomiting.  In  some  cases  slight  catharsis  is  also  produced.  The  pulse 
is  always  increased  in  force  and  frequency.  According  to  the  experi- 
ments of  Dr.  Massie,  from  the  administration  of  a  single  dose,  the 
pulse  becomes  accelerated  in  about  ten  minutes,  but  returned  to  its 
natural  beat  in  from  one  to  two  hours.  In  some  cases  it  extends  its 
action  to  the  uterus,  promoting  the  menstrual  discharge.  By  some,  too, 
it  is  asserted  that  it  possesses  the  power  of  calling  the  pregnant  uterus 
into  action,  and  with  this  view  it  has  been  used  as  a  means  to  promote 
abortion. 

The  principal  action  of  this  agent  seems  to  be  directed  to  the  gastro- 
pulmonary  mucous  tissue,  and  it  may  be  used  wherever  it  is  desirable  to 
make  a  stimulating  impression  upon  this  tissue  with  the  view  of  pro- 
moting free  secretion. 

The  history  of  the  introduction  of  this  article  into  practice  is  the  fol- 
lowing: — Upwards  of  a  hundred  years  ago  (1735)  a  respectable  physi- 
cian of  Virginia,  Dr.  Tennent,  first  obtained  a  knowledge  of  the  use  of 
this  remedy  from  the  Senagaroo  Indians,  by  whom  it  was  considered  as 
a  specific  against  the  bite  of  the  rattlesnake.  From  his  own  experience 
he  was  induced  to  believe  in  its  virtues  in  these  cases,  and  from  the 
analogy  which  he  supposed  to  exist  between  these  and  pleurisy,  he 
recommended  it  also  in  this  disease.  In  1739  he  wrote  and  published  a 
pamphlet  on  the  subject — one  of  the  earliest  medical  publications  which 
appeared  in  this  country.  About  forty  years  ago,  it  was  first  recom- 
mended by  Dr.  Archer,  of  Maryland,  as  an  important  remedy  in 
cynanche  trachealis,  a  disease  in  which  it  still  retains  its  reputation.. 

Form  of  Administration. — Decoction. — Prepared  by  boiling  §  ss  of  the 
bruised  root  in  a  pint  of  water,  until  it  is  reduced  to  half  a  pint,  and 
then  straining.  Of  this,  to  a  child,  a  teaspoonful  is  to  be  given  every 
half  hour  or  hour,  according  to  the  urgency  of  the  symptoms,  and  at 
intervals  a  few  drops  to  keep  up  the  stimulus  until  it  acts  either  as  an 
emetic  or  purgative. 

To  an  adult  give   3  ij  to   §  iij. 

Syrup  of  Senega,  U.  S.  Disp.  dose,  3  i  to  3  iij. 

*  Massie,  p.  191. 


KM-KCTOItANTS.  210 


BOILLA    MAKITIMA. 


Under  the  head  of  Emetics,  this  sul (.stance  has  been  already  described. 
Tlie  general  operation  of  the  squill  is  stimulant.  Upon  the  mucou 
membrane  of  the  lungs  it  acts  in  an  especial  manner,  exciting  and  pro- 
moting its  secretory  process.  When  given  in  considerable  doses  the 
squill  acts  powerfully  on  the  nervous  system,  producing  nausea,  dimi- 
nishing the  action  of  the  pulse,  <fec.  As  an  expectorant  it  may  be  used 
in  all  those  cases  of  disease  of  the  pulmonary  organs,  where  the  exha- 
lants  are  in  a  debilitated  state,  and,  as  a  consequence,  the  bronchial  tubes 
crowded  with  mucus. 

The  common  form  in  which  it  is  used  as  an  expectorant  is  the  oxymel 
or  syrup.     Dose,  30  drops  to   3  b 


SANGUINARIA    CANADENSIS. 

This  plant  is  known  by  a  variety  of  common  names,  such  as  the 
blood  root,  imccoon,  re<^  root,  blood  wort,  red  turmeric,  Indian  paint,  &c. 
This  latter  name  is  derived  from  the  use  made  of  it  by  the  Indians  as  a 
paint,  not  merely  for  their  own  persons,  but  for  their  baskets  and  various 
other  articles.  It  is  a  beautiful  delicate  perennial  vegetable,  growing  to 
the  height  of  six  or  eight  inches,  and  terminating  in  a  single  flower.  It 
grows  in  abundance  in  almost  every  part  of  the  United  States,  and  is  one 
of  the  earliest  plants  flowering  in  the  spring.  Every  part  of  the  plant 
possesses  active  properties,  but  the  root  only  is  used.  This  is  from  two 
to  three  or  four  inches  in  length,  and  from  a  quarter  of  an  inch  to  an 
inch  in  thickness,  and  of  a  fleshy  consistence.  Externally  it  is  reddish 
brown,  internally  bright  red.  When  cut  or  broken,  it  pours  out  from 
numerous  points  of  the  surface  a  bright  orange-colored  juice  of  a  bitter 
taste.  From  this  it  derives  its  name  of  blood  root.  The  same  juice 
pervades  every  part  of  the  plant.  By  drying,  it  loses  70  per  cent,  of  its 
weight,  diminishes  somewhat  in  size,  and  becomes  wrinkled  and  twisted. 
Its  taste  is  bitter  and  acrid,  leaving  a  durable  sense  of  acrimony  in  the 
fauces.  Its  odor  is  slightly  narcotic.  The  color  of  its  powder  is  a  brown- 
ish orange  red. 

By  Prof.  Dana,  an  alkaline  principle  was  detected  in  this  root,  which 
he  called  sanguinarine.  Blood  root  yields  its  virtues  to  water,  wine,  and 
alcohol,  though  in  different  proportions.  The  watery  preparations  are 
more  nauseating,  but  less  bitter  and  acrid  than  the  alcoholic. 

Effects. — These  vary  very  much  with  the  dose.  If  the  powder  be 
snuffed,  it  irritates  the  schueiderian  membrane,  causing  sneezing  and 
increased  secretion  from  the  part.     Taken  internally,  in  small  and  re- 

15 


220  MATERIA   MEDICA   AND   THERAPEUTICS. 

peated  doses,  it  makes  a  peculiar  impression  on  the  mucous  membrane 
of  the  stomach,  increasing  secretion,  exciting  the  appetite,  and  improv- 
ing digestion.  The  liver  js  also  excited  into  action,  with  increased 
secretion  of  bile.  On  the  mucous  tissue  of  the  pulmonary  organs  an 
analogous  effect  is  produced,  and  increased  secretion  succeeds.  During 
its  use  in  this  way  the  pulse  is  gradually  and  moderately  increased  in 
force  and  frequency.  Sometimes  it  excites  the  menstrual  secretion,  and 
in  some  cases,  according  to  Dr.  Tully,  "  it  has  been  known  to  produce 
uterine  haemorrhage." 

In  larger  doses,  it  produces  nausea,  and  abates  the  force  and  fre- 
quency of  the  pulse.  In  still  larger,  it  produces  prompt  and  active 
vomiting. 

If  the  dose  be  excessive,  it  causes  vomiting,  burning  in  the  stomach, 
faintness,  vertigo,  diminished  vision,  coldness,  extreme  reduction  of  the 
pulse,  and  great  prostration. 

The  uses  of  this  article  are  various.  According  to  the  manner  in 
which  it  is  used,  it  operates  as  an  alterative,  an  expectorant,  an  emetic, 
or  a  narcotic.     It  resembles  colchicum  a  good  deal. 

Forms  of  Administration. — Substance. — The  best  form  of  giving  this 
is  in  pill,  in  consequence  of  the  irritation  which  the  powder  produces  in 
the  fauces.  When  the  alterative  and  expectorant  effects  are  required? 
five  grains  in  pill  may  be  repeated  every  two  or  three  hours.  For  an 
emetic,  from  ten  to  twenty  grains  is  a  dose. 

Tincture. — This  is  prepared  by  macerating  four  ounces  of  the  bruised 
root  in  two  pints  of  diluted  alcohol,  for  fourteen  days,  and  then  strain- 
ing. Of  this,  from  20  to  30  drops  may  be  given,  repeated  every  two  or 
three  hours,  increasing  the  quantity,  as  the  stomach  will  bear,  to  60  or 
100  drops,  as  an  alterative  or  expectorant.  As  an  emetic,  from  two 
to  four  drachms  will  be  a  sufficient  dose,  repeated,  if  necessary,  till  it 
operates. 

All  the  preparations  of  Sanguinaria  are  impaired  by  keeping. 


ARUM    TRIPHYLLUM. 

This  is  known  by  the  common  names  of  the  Indian  turnip,  Dragon 
root,  and  Wake-robin.  It  is  a  native  of  this  continent,  grows  in  every 
part  of  the  United  States,  and  is  found  generally  in  rich  swampy,  and 
shady  grounds.  The  part  used  in  medicine  is  the  root,  which  is  bul- 
bous like  the  common  turnip.  It  is  about  one  or  two  inches  in  diame- 
ter, covered  with  a  brown,  wrinkled  epidermis,  and  internally  white  and 
solid.  In  its  fresh  state,  the  root  has  a  peculiar  smell  and  an  extremely 
acrid  taste ^  and  when  chewed,  causes  a  severe  sense  of  burning  and 
pricking    in   the  mouth,  which  continues    for   several  hours.     When 


33XPKCTOKANTS.  22] 

dried,  it  produces  no  effect  of  this  kind.  This  acrimony  appears  to  de- 
pend upon  a  peculiar  principle,  which  is  exceedingly  volatile,  and  is 
generally  dissipated  by  drying  or  simple  exposure  to  the  air,  So  com- 
pletely is  this  dissipated  by  tlie  application  of  heat,  that  it  is  converted 
into  a  mild,  farinaceous,  and  nutritious  substance,  resembling  starch, 
According  to  Dr.  IJigelow,  it  appears  that  the  active  properties  of  thi 
substance  are  not  imparted  to  any  menstruum,  neither  water,  alcohol, 
ether,  nor  olive  oil. 

Effects. — In  its  recent  state  this  root  is  a  powerful  local  stimulant. 
It  causes  a  peculiar  impression  on  the  mucous  membrane  of  the  mouth 
and  throat,  stimulating  it,  and  producing  copious  secretion  from  sur- 
rounding glands.  The  same  impression  is  made  on  the  mucous  mem- 
brane lining  the  (.esophagus  and  stomach,  as  well  as  that  of  the  trachea 
and  lungs.  On  the  circulation  its  effect  is  stimulant,  although  not  so 
much  so  as  might  be  supposed  from  the  local  effect  which  it  produces 
on  the  mouth.  The  use  of  this  article  is  principally  limited  to  those 
cases  in  which  a  stimulant  impression  is  required  to  be  made  upon  the 
mucous  lining  of  the  fauces  and  pulmonary  organs,  with  the  view  of 
producing  secretion.  Hence,  it  has  been  used  in  chronic  catarrh,  per- 
tussis, asthma,  &c. 

Mode  of  Administration. — -In  its  recent  state  it  is  too  acrid  for  use. 
When  perfectly  dried  it  is  inert.  The  recently  dried  root  which  still 
retains  a  sufficient  portion  of  the  acrid  principle,  is  the  state  in  which 
it  is  used.  By  burying  the  root  in  sand,  and  keeping  it  in  a  cellar,  it 
may  be  preserved  for  a  great  length  of  time  fit  for  medicinal  use ;  it 
may  also  be  preserved  by  keeping  it  in  tightly  stopped  bottles  after  it 
has  been  dried.  As  the  properties  of  this  root  are  not  imparted  to  any 
menstruum,  the  best  form  of  giving  it  is  substance,  in  doses  of  six  or 
ten  grains  (gradually  increased),  two  or  three  times  a  day.  This  may 
be  taken  mixed  in  milk. 

The  powder  made  into  a  paste  with  honey  or  syrup,  and  put  into  the 
mouth,  forms  a  good  local  application  for  aphtha?  in  children. 


GUM    AMMONIAC. 

This  is  the  product  of  the  Dorema  ammoniacum,  a  plant  growing 
native  in  Persia.  It  rises  to  the  height  of  six  or  seven  feet,  the  part 
used  is  the  concrete  juice.  The  whole  of  the  plant  is  pervaded  by  a 
milky  juice,  which  exudes  from  it  on  the  slightest  puncture.  In  the 
month  of  May  the  plant  is  attacked  by  an  insect  of  the  beetle  tribe 
which  pierces  it  in  all  directions.  From  these  punctures  the  juice  ex- 
udes and  concretes,  and  is  then  collected  by  the  natives.  It  is  sent  to 
India,  from  whence  it  is  brought  to  Europe.     Ammoniac  comes  in  two 


222  MATERIA  MEDICA   AND   THEKAPETJTICS. 

forms — either  in  separate  dry  tears  {ammoniac  in  the  tear),  or  in  masses 
composed  of  agglutinated  tears  {lump  ammoniac). 

In  the  form  of  tears,  ammoniac  is  irregular  in  its  shape,  generally 
more  or  less  globular.  Externally,  of  an  opaque  yellowish  color ;  in- 
ternally, whitish ;  at  ordinary  temperatures,  moderately  hard  and 
brittle ;  but  softening  in  the  hand  like  wax.  The  masses  are  of  a 
darker  color,  and  less  uniform  in  their  structure.  They  are  composed  of 
agglutinated  tears  imbedded  in  a  brownish  substance,  and  frequently 
mixed  with  various  impurities,  such  as  fragments  of  vegetables, 
sand,  &c. 

Gum  ammoniac  has  a  faint,  unpleasant  smell.  This  odor  is  peculiar, 
and  by  it  the  gum  may  be  identified.  Its  taste  is  bitter,  nauseous,  and 
somewhat  acrid.  According  to  the  analysis  of  Bucholtz,  this  substance 
contains  in  100  parts,  72  resin,  22-4  gum,  1*6  bassorin,  4  volatile  oil, 
including  loss  and  water ;  it  is  partly  soluble  in  water,  alcohol,  ether, 
and  vinegar.  When  triturated  with  water,  a  milky  solution  is  formed, 
which,  after  standing  a  short  time,  precipitates  a  resinous  deposit.  As 
all  the  virtues  of  the  ammoniac  reside  in  the  gum,  the  proper  menstruum 
is  water. 

Effects. — Gum  ammoniac  is  stimulating  in  its  operation,  and  acts 
chiefly  on  the  mucous  membrane  of  the  pulmonary  organs.  According 
to  the  condition  of  these  organs,  it  either  lessens  or  increases  secretion 
and  expectoration.  Where  secretion  is  excessive  from  debility,  it 
lessens  it,  and  where  it  is  scanty  from  torpor,  it  promotes  it.  Its  most 
common  use  now  is  as  an  external  application,  combined  with  mercury. 

Form. — Substance,  in  the  form  of  pill  in  doses  of  from  ten  to  thirty 
grains. 

It  enters  into  the  composition  of  the  compound  squill  pill,  noted  in 
chronic  coughs. 

Mistura  ammoniaci,  commonly  called  the  lac  ammoniac,  made  by 
rubbing  up  3  ii  of  pulverized  ammonia,  with  §  viij  of  water.  On 
standing,  the  resin  subsides.      §  ss  at  a  dose  three  or  four  times  a  day. 

In  the  form  of  plaster,  a  good  local  stimulant  and  discutient. 

Enip.  Ammoniaci  cum  Hydrargyro  {Empldtre  de  Vigo)  is  the  best 
form,  and  is  an  excellent  application  to  indolent  tumors.  It  is  some- 
times put  over  the  liver  to  relieve  congestion  of  that  organ.  It  has 
produced,  when  thus  used,  ptyalism. 

BALSAM    OF   PERU. 

This  is  the  product  of  the  Myrospermum  peruiferum,  a  tall  and 
beautiful  tree  growing  in  various  parts  of  South  America,  especially 
Peru  New  Granada,  and  Columbia.  The  wood  of  the  tree  is  very 
durable,  and  is  employed  for  the  purpose  of  building. 


EXPECTORANTS.  223 

There  are  two  ways  in  which  the  balsam  is  obtained  by  inci  ioi 
into  the  bark  of  the  tree,  and  by  boiling  the  trunk  and  branches  in 
water.  When  incisions  are  made  into  the  tree,  the  balsam  ooze  out  in 
a  white  liquid  form,  which,  if  collected  in  bottles,  may  be  pre  erved  in  a 
fluid  state  for  many  years.  This  is  called  the  white  liquid  balsam  ; 
when  collected  in  mats  and  calabashes,  it  concretes  into  a  resinous  state, 
and  is  then  called  the  dry  white  balsam. 

When  the  balsam  is  obtained  by  boiling  the  bark  of  the  tree  or  the 
smaller  branches  in  water,  a  dark-colored  fluid  is  obtained,  which  is 
called  black  Peruvian  balsam.  This  remains  liquid,  and  is  the  balsam 
of  Peru  known  in  medicine. 

This  article  is  brought  into  this   country  in  tin  canisters,  and  is  a 
viscid  fluid,  of  a  dark  reddish  brown  color,  of  the  consistency  of  syrup 
or  treacle,  has  a  fragrant  odor  and  a  warm  acrid  taste,  leaving,  -when 
swallowed,  a  pricking  sensation  in  the  throat.     Its  chief  constitui 
are  resin,  a  peculiar  volatile  oil,  and  benzoic  acid. 

Alcohol  entirely  dissolves  balsam  of  Peru.  Boiling  water  extracts  the 
Benzoic  acid. 

Purity. — Sometimes  adulterated  with  fixed  oil;  sometimes  with 
alcohol. 

The  first  of  these  is  detected  by  dissolving  in  alcohol.  If  pure,  it  is 
entirely  dissolved.     If  any  fixed  oil  is  present  it  will  not  dissolve. 

The  second  is  detected  by  mixing  it  with  water,  and  shaking  in 
a  graduated  glass  tube.  If  mixed,  the  liquor  becomes  milky,  and  after 
it  has  settled,  and  the  balsam  and  water  have  separated,  the  balsam  is 
found  to  have  diminished  in  bulk,  and  the  water  to  have  increased. 
This  is  owing  to  the  alcohol  uniting  with  the  water  and  leaving  the 
balsam.  The  loss  of  bulk  of  the  balsam  indicates  the  extent  of  the 
adulteration. 

Effects. — A  stimulating  expectorant.  In  full  doses  it  is  apt  to  quicken 
the  circulation  and  create  thirst.  As  a  local  application,  it  is  a  useful 
stimulant  in  exciting  indolent  ulcers,  <fcc.     Not  much  used  internally. 

Dose. — Twenty-five  to  thirty  drops,  taken  on  sugar,  or  made  up  into 
pill,  three  or  four  times  a  day. 


BALSAM    OF   TOLU. 

This  has  generally  been  supposed  to  be  the  product  of  the  Balsanium 
toluifera.  It  is  nowr,  however,  considered  as  the  product  of  Myro- 
spermum  toluiferum,  a  beautiful  tree  growing  in  various  parts  of  South 
America,  especially  in  Carthagena,  and  the  mountains  of  Tolu. 

The  balsam  is  obtained  by  incisions  made  in  the  bark  of  the  trunk  and 
larger  branches,  from  which  it  oozes  out,  and  is  collected  in  proper  vessels. 


224  MATERIA   MEDICA  AND  THERAPEUTICS. 

It  is  brought  to  this-  country  from  Carthagena  in  tin  canisters,  earthen 
jars,  and  sometimes  in  calabashes.  When  first  imported,  balsam  of  Tolu 
is  a  viscid  tenacious  fluid,  of  a  yellowish  brown  color,  with  a  highly 
fragrant  odor  and  an  aromatic  sweetish  taste.  By  keeping  it  becomes 
hai'd  and  brittle,  like  resin,  having  something  of  a  crystalline  appearance. 

According  to  analysis,  it  contains  in  100  parts,  eighty-eight  parts  of 
resin,  12  Benzoic  acid  and  0*2  volatile  oil.  It  is  entirely  dissolved  by 
alcohol ;  boiling  water  extracts  its  benzoic  acid. 

Effects. — The  same  as  the  balsam  of  Peru,  a  stimulating  expectorant, 
used  in  chronic  catarrhal  affections,  promoting  the  secretions  of  the 
mucous  membrane  of  the  lungs,  when  deficient  from  torpor.  From  its 
pleasant  flavor  it  is  much  used  as  an  adjunct  to  expectorant  mixtures. 

Mode  of  Administration, — Dose  from  ten  to  thirty  grains,  frequently 
repeated,  made  into  an  emulsion  by  trituration  with  gum  arabic  and  sugar. 

Tincture. —  3  ss  to  3  ii.  From  its  stimulating  nature  not  much  used 
alone — generally  added  to  other  mixtures. 

Syrup. — This  is  inert  as  a  medicine,  and  is  generally  used  to  flavor 
other  expectorant  mixtures. 


This  is  the  product  of  the  Balsamodendron  myrrha,  a  small  tree 
growing  in  Arabia  Felix.  The  part  used  in  medicine  is  the  juice,  which 
exudes  spontaneously  (like  the  cherry  tree  gum)  from  the  bark  of  the 
tree,  and  concretes  upon  it.  When  it  first  exudes,  it  is  of  a  soft,  oily 
consistence,  and  of  a  yellowish  color.  As  it  dries  it  becomes  darker  and 
redder  in  its  color.  Formerly  the  best  kind  of  myrrh  was  imported 
from  Turkey,  and  was  called  Turkey  myrrh,  while  an  inferior  kind  was 
brought  from  India.  At  present  Pereira  says  the  greatest  part  is  brought 
from  the  East  Indies.  "It  is  said  the  India  myrrh  is  collected  in 
Abyssinia,  and  thence  taken  to  the  ports  of  Hindostan,  while  that  which 
goes  under  the  name  of  Turkey  myrrh,  is  brought  from  Arabia  by  the 
route  of  Egypt." 

Myrrh  comes  in  small  irregular  fragments  like  tears,  or  in  large  masses 
composed  of  agglutinated  portions.  When  good,  it  is  of  a  reddish 
yellow  color,  and  translucent,  has  a  fragrant  odor,  and  a  bitter  aromatic 
taste.  These  are  the  properties  of  Turkey  myrrh.  The  East  India  is 
frequently  much  inferior  in  quality.  It  is  much  darker  colored,  more 
opaque,  and  less  odor.     It  also  abounds  more  in  impurities. 

Its  chief  constituents  are  gum,  resin,  volatile  oil,  and  bassorin. 

Myrrh  is  partially  soluble  in  water,  alcohol,  and  ether. 

Effects. — Myrrh  is  stimulant  and  tonic  in  its  operation.  Its  effects 
are  developed  principally  upon  the  lungs  and  upon  the  uterine  organs. 


EXPECTORANTS.  '2.1?> 

It  is  accordingly  considered  as  an  expectorant  and  emmenagogue,  as  it 
is  stimulant  in  its  action  ;  it  can  only,  of  course,  be  used  in  cases  marl  ed 
by  debility,  and  wbere  there  is  a  total  absence  of  febrile  and  inflam- 
matory excitement. 

The  diseases  in  which  it  has  been  used  are  chronic  catarrh,  humoral 
asthma,  phthisis  pulmonale,  and  other  pulmonary  affections,  in  which 
there  is  excessive  secretion,  but  a  deficiency  of  power  to  expectorate. 
It  is  also  used  with  advantage  as  a  local  stimulant  to  spongy  gums, 
ulcerated  throat,  and  foul  ulcers. 

Form  of  Administration. — It  may  be  given  in  powder  or  pill  in  the 
dose  of  from  10  to  30  grains. 

It  is  generally,  however,  given  in  combination,  and  enters  into  the 
composition  of  a  number  of  officinal  preparations;  among  these  the 
following  are  the  most  important. 

1.  Mistura  Ferri  composita. 

2.  Tinct.  Aloes  cum  Myrrh. 


ANTISPASMODIC    EXPECTORANT   ARTICLES. 

To  this  general  head  belong  all  the  relaxing  articles.  There  are  a 
few,  however,  which  may  be  said  to  operate  more  directly  upon  the  pul- 
monary organs  in  the  way  of  allaying  spasm. 


TOBACCO  IN  THE  FORM  OF  SMOKE. 

Tobacco  operates  in  two  ways  upon  the  pulmonary  organs,  in  both  of 
which  its  influence  may  be  salutary  ;  it  increases  secretion  from  the  mu- 
cous membrane  lining  the  respiratory  tubes,  and  by  its  general  narcotic 
influence  on  the  nerves  and  on  the  circulation  it  allays  irritation  and 
alleviates  cough.  In  spasmodic  affections  of  the  chest,  such  as  asthma, 
smoking  has  accordingly  been  used  frequently  with  advantage. 


STRAMONIUM    IN    THE    FORM    OF    SMOKE. 

The  general  effects  of  stramonium  as  a  narcotic  will  be  noticed  under 
that  head.  Introduced  into  the  system  in  the  form  of  smoke  of  the 
dried  herb,  it  has  long  been  a  popular  remedy  in  spasmodic  asthma,  and 
in  many  cases,  unquestionably,  has  proved  beneficial.  Like  tobacco,  it 
operates  locally  and  generally.  It  allays  irritation  of  the  mucous  mem- 
brane, and  thus  promotes  free  secretion,  while  at  the  same  time,  by  its 
general  operation  on  the  nervous  system,  it  counteracts  spasm  and  ren- 
ders respiration  more  free  and  uniform. 


226  MATERIA   HEDICA  AND   THERAPEUTICS. 


VAPOR    OF    SULPHURIC    ETHER. 

This  is  used  by  simply  putting  a  couple  of  teaspoonfuls  of  ether  into 
a  cup  and  holding  it  to  the  mouth.  The  warmth  of  the  hand  applied 
to  the  cup  is  sufficient  to  cause  an  evaporation  of  the  ether  which  is 
thus  inhaled.  This  may  be  repeated  three  or  four  times  a  day,  and  is 
useful  in  catarrh  and  whooping-cough. 


EXPECTORANT    EMETICS. 

The  act  of  vomiting  may  prove  curative  in  diseases  of  the  lungs  by  its 
general  operation  on  the  circulation  and  on  the  secretions  of  the  mucous 
lining  of  the  lungs,  promoting  secretion  in  some  cases,  and  separating 
viscid  secretions  already  formed  in  others,  or  by  expelling  secreted  mat- 
ters. During  the  contraction  of  the  diaphragm  and  abdominal  muscles 
an  impulse  is  communicated  to  the  whole  bronchial  system.  In  conse- 
quence the  expiratory  effort  is  increased,  and  the  expulsion  of  mucus  and 
other  matters  from  the  pulmonary  tubes  is  brought  about. 

Now  the  kind  of  emetic  used  must  differ  according  to  the  condition 
of  the  system. 

If  inflammation  be  present  tartar  emetic,  ipecac  and  such  articles  as 
nauseate  must  be  used. 

If  there  be  no  fever  or  inflammation,  but  simple  accumulation  of  mu- 
cus or  pus,  sulphates  of  zinc  or  copper. 

In  children  this  distinction  is  essential. 


COMBINATIONS    OF    EXPECTORANTS    WITH    ONE    ANOTHER. 

There  is  perhaps  no  class  of  medicinal  agents  more  uniformly  given 
in  combination  than  expectorants,  and  with  the  greatest  advantage.  The 
principle  on  which  these  combinations  are  made  is  simple  and  obvious, 
that  of  uniting  the  different  modes  in  which  these  agents  produce  their 
effects.  As  already  stated  some  expectorants  operate  locally  and  directly 
upon  the  lungs.  Others  produce  their  effects  by  impressions  made  upon 
neighboring  parts  and  transmitted  to  the  lungs.  "Now  to  a  greater  or 
less  extent  the  effect  of  these  different  modes  may  be  united  in  one  pre- 
scription. For  the  purpose  of  illustrating  this  let  us  run  over  some  of 
the  articles  belonging  to  this  class. 

Demulcent  substances,  such  as  liquorice,  gum  arabic,  &c.  These  are 
given  alone  in  the  form  of  solutions  when  you  wish  simply  to  obtain 
their  soothing  effects  upon  the  fauces.     Usually,  however,  they  are  given 


EXPECT0BANT8.  227 

in  combination  with   other  substances  to  render  them  more  efficient. 
They  form  the  basis  of  almost  all  expectorant  mixtures. 

Ipecacuanha. — This  is  frequently  given  alone.  Usually  it  is  added  to 
the  demulcent  vehicles  already  mentioned,  and  in  that  way  you  get  an 
excellent  and  efficient  combination  calculated  to  soothe  irritation,  pro- 
mote secretion,  and  moderately  relax  the  system. 

Tartar  Emetic. — This,  as  an  expectorant,  is  usually  given  in  combina- 
tion with  demulcent  articles,  and  you  then  get  the  soothing  effeel  of 
the  latter  with  the  peculiar  and  relaxing  effects  of  the  former.  This 
forms  the  active  ingredient,  in  many  of  the  expectorant  mixtures  which  are 
given  in  cases  where  inflammatory  action  is  present.  The  antimony 
may  be  added  either  in  the  form  of  tartar  emetic  itself  or  of  the  antimo- 
nial  wine. 

Polygala  Senega! — Sometimes  this  is  prescribed  alone  and  yon  then 
get  the  peculiar  effects  of  the  remedy  upon  the  mouth  and  fauces  and 
upper  part  of  the  trachea,  causing  copious  secretions  from  these  puts. 

Senega  is,  however,  stimulating  in  its  nature,  and  therefore  in  cases 
where  this  might  prove   objectionable  it  is  advantageously    combined 
with  tartar  emetic.     A  valuable  combination   of  this  kind  is  the  Hive 
syrup  of  Dr.  Coxe.     This  is  prepared  in  the  following  way. 
B,.     Polygal.  Seneg.  contus. 

Scillse  Marit.  contus.  aa  3  viij. 
Aq.  purse  3  viij. 
Boil  together  over  a  slow  fire  until  the  water  is  half  consumed,  strain  off 
the  liquor,  and  then  add  of  strained  honey  four  pounds.  Boil  the  honey 
and  the  strained  liquor  to  six  pounds,  or  to  the  consistence  of  a  syrup, 
and  add  to  every  pound  of  this  sixteen  grains  of  tartar  emetic,  that  is 
one  grain  to  every  once.  The  dose  varies  from  ten  drops  to  one  or 
more  teaspoonfuls  every  quarter,  half,  or  one  hour,  according  to  the  age 
of  the  patient  or  the  violence  of  the  disease.  This  combination  proves 
expectorant,  emetic,  purgative,  and  diaphoretic. 

Scilla  maritima. — This  is  generally  given  in  combination  either  with 
tartar  emetic,  antimonial  wine,  or  ipecacuanha  wine,  and  you  then  get  the 
united  operation  of  the  two  ingredients — the  peculiar  effect  of  the  squill 
on  the  mucous  lining  of  the  lungs  and  the  general  relaxing  effects  of  the 
antimony  on  the  system.  Accordingly  it  is  observed  that  when  the  skin 
is  hot  and  dry  the  squill  does  not  prove  expectorant  unless  thus  combined 
with  a  relaxing:  and  sudorific  article. 


DIUBETICS 


The  term  Diuretic  is  applied  to  that  class  of  medicinal  agents  which. 
possess  the  power  of  increasing  the  urinary  secretion,  or,  in  other  words, 
of  exciting  into  increased  activity  the  functions  of  the  kidneys. 

In  a  general  sense,  this  class  embraces  a  wide  range  of  agents.  The 
urinary  secretions  may  be  interrupted  from  various  causes.  Thus,  for 
example,  inflammation  of  the  kidneys  will  lessen  the  quantity  of  urine. 
By  the  use  of  venesection  and  other  antiphlogistic  remedies,  the  inflamma- 
tion of  these  organs  is  subdued  and  the  secretion  of  urine  restored.  In 
a  certain  sense,  therefore,  all  these  agents  may  be  considered  as  diuretic. 
It  is  not,  however,  in  this  enlarged  way  that  we  shall  consider  this  class 
of  agents,  but  shall  restrict  it  to  those  which  appear  to  act  directly  in 
promoting  the  urinary  secretion. 

Effects. — In  analysing  these,  it  is  important  to  distinguish  between  the 
effects  produced  upon  the  kidneys  themselves  and  those  which  are  pro- 
duced on  other  parts  of  the  system. 

On  the  Urinary  Organs. — The  effects  of  diuretics  are  here  obvious. 
They  increase  the  flow  of  blood  to  the  kidneys,  increase  the  vital  action 
of  these  organs,  and  promote  their  secretory  functions.  In  some  cases, 
active  irritation  and  even  inflammation  of  these  organs  is  the  result. 
Diuretics  may  then  be  considered  as  local  stimulants  to  the  kidneys,  the 
degree  of  stimulation  produced  by  different  articles  differing  [and  also, 
as  appears  from  the  researches  of  Dr.  Golding  Bird,  its  character.  Some 
diuretics  merely  increasing  the  watery  portion  of  the  urine,  while  others 
seem  to  stimulate  the  organ  in  the  performance  of  its  great  function  of 
depurating  the  blood,  and  increase  in  a  very  remarkable  manner  the 
quantity  of  solid  matter  eliminated  in  the  urine.  To  the  former  class 
belong  most  of  the  vegetable  diuretics,  as  squills,  colchicum,  digitalis,  all 
those  agents  which  out  of  the  body  produce  no  chemical  effects  on  ani- 
mal matter.  To  the  latter  belong  all  the  agents  which  have  this  power, 
viz.  the  alkalies,  the  alkaline  carbonates  and  the  alkaline  citrates,  tar- 
trates, acetates,  &c,  these  latter  being  in  the  system  converted  into  car- 
bonates. These  substances  when  circulating  in  the  blood,  and  thus 
brought  into  contact  with  the  different  tissues,  act  chemically  upon  them 
by  combining  with  the  albumen  and  fibrin,  and  making  with  them  a 
solution  which  readily  enters  the  blood  by  endosmose.     On  the  fatty 


DIUItETrCS. 


229 


elements  of  the  tissues  their  action,  though  not  identical,  is  the  same  in 
result,  for  with  them  tlie  alkalies  form  an  emulsion  which  readily 
transudes  animal  membrane,  and,  of  course,  can  pass  both  into  and  out 
of  the  bloodvessels.  It  is  for  this  reason  that  alkalies  are  now  so  much 
used  in  Fevers,  Rheumatisms,  &c,  &c,  in  which  diuretics  have  hitherto 
either  not  been  given  at  all  or  have  not  been  prescribed  understanding]}'. 
—Ed.] 

Effects  on  the  Vascular  System. — Like  all  evacuations  from  the 
system,  the  natural  effect  of  an.  increased  flow  of  urine  is  to  diminish 
the  activity  of  the  circulation.  This  effect,  however,  is  gradual  and 
usually  moderate  in  degree.  As,  however,  many  of  the  articles  are 
stimulants,  the  heart  and  arteries  may  at  first  be  excited.  The  effect, 
therefore,  on  the  circulation,  will  depend  entirely  upon  the  nature  of 
the  diuretic  agent  as  well  as  upon  the  quantity  of  urine  which  may  be 
secreted. 

On  the  blood  itself  some  change  must  also  be  effected.  This  must 
of  course  vary  greatly  in  consequence  of  a  number  of  circumstances. 
If  the  quantity  of  watery  fluid  separated  from  the  blood  and  discharged 
by  urine  be  counterbalanced  precisely  by  the  quantity  taken  up  by  the 
absorbents  from  the  stomach  and  bowels,  then  the  blood  may  remain 
without  much  alteration  in  this  respect.  Generally,  however,  this  is 
not  the  case,  and  then  the  blood  must  vary  in  the  relative  proportion  of 
water  which  it  contains.  In  the  saline  materials  too,  contained  in  the 
blood,  a  considerable  change  takes  place ;  but  what  the  extent  of  these 
changes  in  the  circulating  fluid  is,  and  what  its  precise  nature,  it  is  not 
in  the  present  state  of  our  knowledge  easy  to  say.  Experiments  and 
observations  to  elucidate  these  points  would  no  doubt  lead  to  many 
important  conclusions. 

The  Skin. — Between  the  skin  and  the  urinary  organs  there  is  an 
intimate  sympathy,  and  one  of  the  most  striking  and  immediate  results 
of  an  increase  in  the  secretory  function  of  the  one  is  a  diminution  of 
that  of  the  other.  Hence  in  all  cases  where  diuresis  is  long  continued, 
blood  flows  less  freely  to  the  surface — its  vital  heat  is  lessened  and 
exhalation  is  diminished.  A  striking  illustration  of  these  phenomena  is 
witnessed  in  diabetes.  On  the  other  hand  where  the  urinary  secretion 
is  impaired,  frequently  the  skin  exhales  profusely.  In  cases  of  suppres- 
sion of  urine,  for  instance,  it  has  been  remarked  that  there  was  profuse 
sweating  and  that  the  perspiration  had  a  urinary  smell,*  and  contained 
urea. 

The  Exhalant  System. — The  general  effect  of  continued  diuresis  is  to 
lessen  exhalation  throughout  the  system.  As  already  stated,  such  is 
the~effect  on  the  external  surface  of  the  body.     On  the  mucous  surface 

*  Mackintosh,  vii.  p.  269. 


230  MATERIA   MEDICA   AND   THERAPEUTICS. 

a  similar  effect  appears  to  be  produced.  In  Diabetes,  this  is  illustrated 
in  the  distressing  thirst,  hunger,  and  peculiar  sense  of  emptiness  in  the 
stomach,  which  characterize  this  complaint.*  On  the  serous  surfaces 
we  have  no  means  of  ascertaining  precisely  what  effect  is  produced. 
The  probability,  however,  is  that  the  same  thing  occurs  here.  This 
may  fairly  be  inferred  from  the  fact,  that  when  increased  exhalation 
takes  place  from  the  serous  tissues  (constituting  dropsies)  the  urinary 
secretion  is  usually  impaired,  and  on  the  other  hand,  when  the  urinary 
secretion  becomes  copions,  dropsical  accumulations  lessen  and  disappear. 
The  researches  of  modern  physiologists  have  given  much  distinctness 
to  our  views  of  the  action  of  diuretics.  We  now  know  that  absorption 
being  dependent  on  endosmose,  fluids  will  not  be  taken  up  for  the 
alimentary  canal  unless  their  specific  gravity  is  less  than  1.026  (that 
of  serum),  and  that  when  they  are  so  dilute,  they  are  taken  up  with 
great  rapidity.  We  know  that  the  kidneys  (the  organs  through  which 
the  system  rids  itself  of  superfluous  water)  perform  two  distinct  functions, 
one  that  of  excreting  water,  the  other  that  of  depurating  the  blood.  We 
know  that  these  two  functions  are  independent  the  one  of  the  other, 
that  the  quantity  of  water  in  the  urine  may  be  very  great,  and  yet  the 
depurative  function  be  very  imperfectly  performed,  andj  vice  versa. 
Indeed  we  have  reason  to  believe  that  these  two  functions  are  seated  in 
two  different  tissues  of  the  kidney — that  the  malpighian  bodies  separate 
the  water  from  the  blood,  while  the  uririiferous  tubes  and  their  capil- 
laries eliminate  the  urea,  uric  acid,  &c,  the  solid  constituents  of  the 
urine,  to  which  it  owes  its  peculiar  qualities.  It  is  on  the  former, 
as  before  remarked,  that  the  vegetable  diuretics  and  those  which  have 
no  chemical  action  on  the  vessels,  act,  while  the  alkalies,  &c,  by  chemi- 
cal combination  with  the  elements  of  the  tissues,  facilitate  their  disinte- 
gration, their  passage  into  the  blood,  and  their  subsequent  elimination 
by  the  kidneys. 

On  the  Absorbent  System. — The  general  opinion  of  writers  is,  that 
diuretics  excite  very  powerfully  the  action  of  the  absorbents.  This  was 
the  opinion  of  Dr.  Cullen. 

CIRCUMSTANCES   MODIFYING    THE    EFFECTS   OF    DIURETICS. 

Of  these  there  are  several  which  require  to  be  noticed  as  exercising 
an  important  bearing  on  the  practical  application  of  these  agents. 

1.  Temperature  and  Season  of  the  Year. — Whatever  has  a  tendency 
to  check  the  determination  to  the  skin  increases  the  secretion  of  the 
urinary  organs.  Hence  it  is  that  in  cold  weather  and  in  cold  situations 
the  quantity  of  urine  is  always  increased,  while  in  warm  weather  and 

*  Elliotson. 


DITJBEnCS.  281 

in  warm  latitudes  the  reverse  takes  place.     For  the  same  reason  diure- 
tics act  more  powerfully  on  the  kidneys  in  cold  than  in  warm  weather. 

2.  The  Quantity  and  T£ffiJ28£&iy£&  "J  th&  Finn!  taken  during  their 
U86t — Free  dilution  aids  very  materially  the  effect  of  diuretics,  provided 
the  diluent  be  cold,  [f  it  be  warm,  instead  of  determining  to  the  kid- 
neys, it  may  pass  off  by  the  skin.  So  remarkably  does  the  eff  cl  of 
these  agents  depend  upon  the  temperature  of  the  diluent,  thai  the  same 
article  may  frequently  be  rendered  diuretic  or  diaphoretic,  according 
the  diluent  is  cold  or  warm.  Spiritus  JMindcrcri,  for  example,  which  if 
taken  with  warm  drinks  is  diaphoretic,  acts  as  a  diuretic,  if  the  drinks 
be  cold  and  the  person  be  kept  cool  at  the  same  time.  On  the  other 
hand,  the  salt  of  tartar  and  nitre  are  powerful  diuretics,  yet,  when  laken 
with  warm  drinks  and  tin;  body  kept  warm  they  prove  sudorific,  with- 
out acting  on  the  kidneys  at  all. 

3.  The  form  in  which  they  are  given. — This  exercises  a  controlling 
influence  on  the  operation  of  diuretics,  especially  the  salines,  many  of 
which,  if  given  in  strong  solution,  act  as  purgatives,  by  causing  an 
endosmosis  from  the  intestines  to  the  saline  solution ;  while  if  given 
largely  diluted,  so  that  the  specific  gravity  of  the  fluid  is  less  than  1.026 
(that  of  the  serum  of  the  blood),  they  are  readily  absorbed,  and  being 
carried  to  the  kidneys  are  thence  eliminated  with  the  urine,  and  act  as 
diuretics. 

4.  The  Condition  of  the  Skin. — As  already  stated,  there  is  a  recipro- 
cal relation  between  the  skin  and  the  kidneys.  If  the  excretion  from 
the  one  be  augmented,  that  from  the  other  is  lessened.  Hence,  if  the 
skin  be  in  a  moist  state,  diuretics  produce  little  effect.  For  the  same 
reason,  if  the  patient  exercises  freely  during  their  use,  their  operation  is 
interfered  with. 

5.  The  Condition  of  the  Bowels. — There  is  perhaps  no  one  circum- 
stance which  so  greatly  modifies  the  effect  of  this  agent  as  the  state  of 
the  bowels.  Thus,  during  the  use  of  diuretics,  if  the  bowels  become 
relaxed,  the  effect  on  the  kidneys  will  be  arrested ;  of  this  we  have 
numerous  illustrations.  Turpentine,  which  if  given  in  small  doses  acts 
powerfully  on  the  urinary  organs,  loses  this  property  altogether,  if  given 
in  doses  sufficiently  large  to  prove  cathartic.  Nitre,  when  given  alone, 
is  one  of  our  most  decided  diuretics,  and  its  presence  may  be  detected 
in  the  urine.  But  if  this  be  combined  with  some  cathartic,  it  fails  in 
this  respect,  and  it  can  no  longer  be  detected  in  the  urine. 

5.  The_Conditiort  of  the  System  as  to  Disease. — In  certain  diseased 
states,  particularly  dropsy,  the  action  of  diuretics  is  exceedingly  uncer- 
tain'; this  we  now  know  to  depend  on  the  fact  that  a  large  proportion 
of  dropsies  are  caused  by  organic  disease  of  the  kidneys,  the  liver,  or 
the  heart.  Now,  if  the  kidney  be  disorganized,  it  cannot  perform  its 
function,  and  it  is  worse  than  in  vain  to  goad  it  with  stimulants — as 


232  MATERIA   MEDICA   AND   THERAPEUTICS. 

well  stimulate  an  apoplectic  brain  or  a  lacerated  muscle.  If  the  liver 
is  diseased  the  portal  circulation  is  so  obstructed  that  the  kidneys  do 
not  receive  their  due  amount  of  the  raw  material  from  which  they  are 
to  manufacture  the  urine.  They  cannot  produce  urine  when  its  ele- 
ments are  not  supplied  them.  So  with  disease  of  the  heart — the  circu- 
lation is  interrupted,  and  till  that  difficulty  is  removed  we  stimulate  the 
kidneys  to  no  possible  purpose.  It  is  in  these  heart  dropsies,  that  digi- 
talis, by  its  soothing  power  over  the  disturbed  circulation,  acts  as  a 
diuretic. 

MODES    IN    WHICH    DIURETICS    PROVE    CURATIVE. 

1st.  As  local  stimulants.  In  this  way  they  operate  when  the  kidneys 
are  torpid  and  inactive ;  they  restore,  by  their  direct  circulation,  energy 
to  the  organ,  and  promote  the  secretion  of  urine. 

2d.  By  their  agency  in  the  removal  of  dropsical  accumulations — this 
has  already  been  alluded  to. 

[3d.  By  their  effect  in  increasing  the  depurative  function  of  the  kid- 
neys, and  thus  increasing  the  waste  of  matter,  they  may  promote  the 
removal  of  diseased  products  of  low  vitality,  which  often  present  them- 
selves either  in  the  form  of  albuminous  deposits  in  the  glands,  furuncular 
diseases  of  the  cellular  tissues,  or  incrustations  on  the  skin,  as  in  some  of 
the  tuberculous  cutaneous  diseases. — Ed.] 

APPLICATION    OF    DIURETICS    IN    THE    TREATMENT    OF    DISEASES. 

A  few  observations  will  serve  to  show  the  extent  to  which  these 
agents  may  be  applied. 

Fevers. — Like  every  other  organ  destined  to  the  purposes  of  secre- 
tion, the  kidneys  are  more  or  less  deranged  in  every  case  of  fever. 
Hence,  not  merely  the  quantity  of  urine  is  lessened,  but  the  character 
of  it  is  changed  in  various  degrees.  Now,  in  the  management  of  fever 
one  of  the  great  objects  to  be  accomplished  is  to  restore  all  the  secre- 
tions. This  holds  true  no  less  of  the  urinary  secretion  than  it  does  of 
the  others.  As  a  general  rule,  however,  the  accomplishment  of  this 
object  does  not  require  the  use  of  specific  diuretics.  The  condition  of 
the  kidneys  in  fever  is  consequent  upon  the  morbid  states  of  the  san- 
guineous and  nervous  system,  and  the  most  efficient  mode  of  restoring 
the  urinary  secretion  is  by  the  use  of  those  remedies  which  are  resorted 
to  for  the  purpose  of  subduing  general  excitement.  Except  in  particu- 
lar cases,  therefore,  mere  diuretics  are  not  remedies  that  can  be  ren- 
dered very  available.*     Among  this  class  of  agents,  however,  there 

*  [The  views  of  G.  Bird,  before  alluded  to,  tend  to  modify  the  opinion  here 
e-spressed,  and  to  extend  the  uses  of  these  agents  in  fever. — Ed.] 


are  some  which  possess  other  properties  which  render  them  r< 
quently  beneficial.  This  is  the  case  with  nitre,  which  i  refrigerant 
as  well  as  diuretic;  so  also  cream  of  tartar  is  refrigeranl  and  ! 
tive.  These,  therefore,  7iuiy  be  prescribed  with  great  benefit.  As  a 
general  rule  it  may  be  lai<l  down  that  only  such  diuretics  are  to  be 
used  as  cooperate  with  the  general  indications  of  cure.  A.8  a  mat- 
ter of  course  this  excludes  the  use  of  all  stimulating  and  irritating 
agents. 

[One  diuretic,  and  that  a  most  certain  and  efficient  one,  can  almost 
always  be  used  with  great  advantage.  I  mean  cold  water ;  plentiful 
dilution  with  cold  water,  cold  mucilages,  or  very  dilute  solutions  of 
salines,  are  very  generally  both  pleasant  and  useful. — En.] 

Dropsies. — On  the  general  nature  of  dropsical  disorders  I  have  al- 
ready said  something  when  speaking  of  the  use  of  cathartics.  In  the 
management  of  them  there  is  no  class  of  remedies  which  has  been  so 
universally  resorted  to  as  diuretics.  This  has  no  doubt  arisen  from  the 
obvious  fact  that  in  dropsies  the  secretion  of  urine  is  always  more  or 
less  impaired,  and  that  when  they  yield  the  secretion  is  generally 
increased.  A  leading  indication,  therefore,  has  always  been  to  endeavor 
by  every  possible  means  to  excite  the  urinary  secretion,  and  for  this 
purpose  diuretics  have  been  extensively  used.  In  the  application  of  this 
class  of  agents  discrimination,  however,  is  necessary,  and  it  is  to  be 
feared  that  for  the  want  of  this,  frequently  more  harm  than  good  results 
from  their  use.  As  frequently  stated  before  this,  dropsies  are  the  mere 
result  of  other  diseased  conditions  of  the  system,  and  to  prescribe  reme- 
dies for  their  removal  especial  regard  must  be  had  to  the  primary  dis- 
ease, as  well  as  to  the  peculiar  symptoms  which  may  present  them- 
selves. And  with  regard  to  no  class  of  remedies  is  this  more  necessary 
than  diuretics,  inasmuch  as  they  have  been  indiscriminately  used  in 
almost  every  form  and  variety  of  dropsy. 

In  some  cases  dropsy  originates  from  a  subacute  inflammation  of  the 
kidneys  terminating  in  organic  disease,  characterized  by  a  peculiar 
granular  deposit,  and  in  all  cases  of  this  kind  the  urine  is  very  coagu- 
lable  by  heat.  For  this  important  observation  in  relation  to  the  con- 
nexion between  coagulable  urine  and  organic  disease  of  the  kidneys,  we 
are  indebted  to  Dr.  Bright,  and  since  then  it  has  been  confirmed  by  the 
investigations  of  Drs.  Gregory,  Christison,  and  Osborne.  Now,  when 
dropsy  is  connected  with  this  state  of  the  kidneys,  diuretics  are  remedies 
which  so  far  from  doing  any  good  are  positively  injurious,  inasmuch  as 
they  are  calculated  directly  to  increase  the  organic  disorder  of  the  kid- 
neys. Indeed  it  appears  to  be  well  established  that  the  too  free  use  of 
diuretic  medicines  sometimes  is  the  cause  of  this  form  of  dropsy.  [I 
should  not  so  absolutely  proscribe  the  use  of  diuretics  in  Bright's  disease. 
They  may  do  harm,  but  they  may  do  good ;  and  in  so  desperate  a  case 


234  MATERIA    MEDICA   AND    THERAPEUTICS. 

we  are  often  driven  to  their  vise.  The  least  irritating  should  of  course 
be  selected,  as  cream  of  tartar  and  digitalis.] 

Where  dropsy  is  connected  with  organic  disease  of  the  heart,  in  con- 
sequence of  which  impediments  take  place  in  the  circulation  through 
this  organ,  digitalis  may  be  used  with  great  advantage.  And  it  operates 
as  a  diuretic  in  two  ways,  by  a  direct  action  on  the  kidneys,  but  more 
especially  by  lessening  the  inordinate  action  of  the  heart,  and  in  this 
way  facilitating  the  circulation  through  the  capillaries. 

[Rheumatism. — The  connection  of  this  disease  with  an  abnormally 
acid  condition  of  the  fluids,  and  its  probable  dependence  on  a  materies 
morbi  of  an  acid  nature  in  the  blood,  are  becoming  recognised  facts  in 
pathology,  and  the  treatment  of  the  disease  by  alkaline  diuretics,  is  by 
most  practitioners  believed  to  be  satisfactory.  To  be  successful,  the 
quantity  of  alkaline  material  given  must  be  large.  Fuller's  favorite 
alkaline  is  the  Rochelle  salt,  which  he  prefers  as  more  agreeable  to  the 
stomach  and  (being  promptly  resolved  in  the  stomach  into  alkaline 
carbonates)  equally  efficient  as  an  antacid.] 


MODUS    OPERANDI    OF    DIURETICS. 

Is  is  to  this  class  of  medicines  that  the  advocates  of  the  doctrine  that 
the  remote  effects  of  remedies  always  depend  on  their  absorption  into 
the  blood,  most  confidently  appeal  in  support  of  their  hypothesis,  and 
there  can  be  no  doubt  that  the  vast  majority,  if  not  the  whole,. of  the 
diuretics  that  are  in  use  are  absorbed  ;  the  only  question  is,  in  what 
state  are  they  to  be  found  in  the  excretions,  for  it  is  probable  that  they 
exist  in  that  same  state  in  the  blood. 

[Some  diuretics  pass  into  and  out  of  the  s)<stem  without  any  change ; 
they  are  found  in  the  urine  in  the  same  state  in  which  they  were  taken 
into  the  stomach.  Such  are  nitre,  carbonate,  and  chlorate  of  potash,  &c. 
Others  are  changed  by  the  reagents  they  encounter  in  the  alimentary 
canal,  and  pass  off  by  the  kidneys  in  a  different  combination,  e.  g. 
tartrate,  citrate,  and  acetate  of  potash  are  changed  into  carbonates.  It 
is  not,  however,  to  be  supposed  that  all  agents  that  pass  off  in  the  urine 
unchanged  are  diuretics,  still  less  that  all  diuretic  agents  pass  off  by 
that  route.  This  we  know  is  not  the  fact,  and  on  the  other  hand,  some 
of  our  most  certain  diuretics  have  not  been  found  in  the  urine,  probably 
because  of  our  imperfect  means  of  detecting  them ;  the  rule  generally 
holding  good,  that  the  substances  that  are  usually  excreted  by  any 
organ  stimulate  it.  There  are,  moreover,  certain  agents  that  prove 
diuretic  by  the  general  impulse  they  give  to  the  whole  system,  especially 
the  secreting  organs.  Of  those  that  act  on  the  whole  system  the  most 
remarkable  are  mental  impressions  ;  of  the  latter,  those  which  stimulate 


mi  i:i;i  !<•  ■■;.  231 


the  secretory  organs  in  particular,  mercury  is  the  example  commonly 

cited. — Ed.  | 


KUXE.H    TO    BE    OHSKKVKI)     IMIUMi     TIIK     I'SK     OK     1)11   IlKTIOH. 

These  maybe  readily  deduced  from  what  lias  been  already  stated. 

1.  Diuretics  should  be  given  in  a  state  of  solution,  and  that  solution 
should  be  so  diluted  as  to  have  a  specific  gravity  decidedly  below  that 
of  the  serum  of  the  blood  (1.025)  ;  that  is,  they  should  not  contain  more 
than  five  per  cent,  of  solid  matters.  If  not  given  in  this  dilute  form,  a 
very  free  use  of  water,  pure,  or  containing  mucilage,  should  follow  them. 
This  is  especially  necessary  where  the  alterative  effect  of  the  diuretic  is 
desired — where  we  merely  desire  to  increase  the  quantity  of  water  it  is 
not  so  important. 

2.  During  their  use,  the  state  of  the  skin  should  be  attended  to,  and  any- 
thing like  perspiration  avoided.  For  this  purpose,  the  patient  should 
be  kept  as  much  as  possible  out  of  bed,  and  the  surrounding  temperature 
be  rather  low. 

3.  Be  careful  that  they  do  not  act  on  the  bowels.  This  will  completely 
counteract  their  operation  on  the  urinary  organs.  For  this  purpose 
where  they  have  any  tendency  to  act  on  the  bowels,  they  should  be 
given  in  small  and  repeated  doses  instead  of  large  ones,  [and  above  all 
things  largely  diluted;  this  renders  their  absorption  nearly  certain,  while 
in  strong  solution  they  cause  exosmosis  into  the  intestines,  and,  of  course, 
purging.]  Combining  a  small  quantity  of  morphia  with  the  diuretic, 
will  often  check  its  purgative  tendency,  probably  by  diminishing  exha- 
lation from  the  mucous  surface  of  the  intestines.  This  would  undoubt- 
edly favor  their  proper  action. 

4.  The  drinks  taken  during  the  use  of  diuretics  should  be  cold. 


INDIVIDUAL    DIUBETICS. 

NITRATE    OF    POTASH. 

This  is  commonly  called  nitre  or  saltpetre.  It  is  found  native  or  pre- 
pared artificially.  In  its  native  state,  it  is  found  effloresced  on  the  sur- 
face of  the  soil  in  several  parts  of  Europe,  Africa,  India,  and  South 
America.  It  is  also  found  in  several  parts  of  the  United  States,  particu- 
larly in  some  of  the  middle  and  western  States — generally  in  caverns  or 
caves  in  limestone  rock.  Most  of  the  nitre  used  in  the  United  States  is 
obtained  from  caves  of  this  kind  in  Kentucky. 

16 


236  MATERIA   MEDICA   AND   THERAPEUTICS. 

It  exists  also  in  certain  vegetables,  as  tobacco,  hemlock,  &c. 

Artificially,  it  is  prepared  by  mixing  up  animal  and  vegetable  remains 
with  ashes  and  calcareous  earth.  These  are  placed  under  sheds  open  at 
each  end  to  admit  the  access  of  air.  They  are  frequently  turned  up 
and  moistened  with  urine,  which  contains  a  great  quantity  of  nitrogen. 
These  are  what  are  called  nitre  beds.  At  the  end  of  a  certain  time  (two  or 
three  years)  the  nitrogen  has  become  converted  into  nitric  acid,  and  this 
uniting  with  the  potassa  in  the  vegetable  remains,  forms  nitrate  ofpotassa. 
For  the  purpose  of  separating  the  nitre  thus  formed  from  the  beds,  they 
are  lixiviated.  This  is  performed  by  pouring  boiling  water  on  the  mass 
to  dissolve  out  the  nitre.  The  solution  thus  obtained,  however,  contains 
also  nitrates  of  lime  and  magnesia.  To  get  rid  of  these,  wood  ashes 
(which  contains  carbonate  of  potassa)  is  added.  This  decomposes  the 
nitrates  of  lime  and  magnesia,  and  furnishes  still  more  nitrate  of  potassa? 
the  nitric  acid  combining  with  the  potassa,  while  the  earthy  bases  are 
precipitated.  Besides  these  nitrates,  it  also  contains  common  salt.  This 
is  got  rid  of  by  evaporating  the  solution,  when  the  salt  rises  to  the 
surface  in  the  form  of  a  scum  and  is  removed.  As  the  solution  now 
cools,  the  nitre  crystallizes  in  dirty  white  crystals,  and  in  this  state  it  is 
called  crude  nitre.     It  still  contains  some  common  salt. 

Before  this  can  be  used  in  medicine,  it  requires  to  be  purified.  This  is 
done  by  boiling  it  in  water,  and  is  founded  on  the  fact  that  nitre  is  more 
soluble  in  water  than  salt.  The  latter,  which  remains  undissolved,  or  is 
precipitated,  is  carefully  removed.  The  solution  is  now  clarified  by  the 
addition  of  glue,  and  then  set  by  to  crystallize. 

Properties. — Nitre  is  a  white  crystalline  salt  without  smell — with  a 
sharp,  bitterish  taste,  causing  a  sense  of  coldness  in  the  mouth  and 
stomach.  It  contains  no  water  of  crystallization.  Air  does  not  affect  it» 
It  is  soluble  in  four  or  five  times  its  weight  of  cold,  and  two  fifths  of  its 
weight  of  boiling  water.  In  alcohol  it  is  insoluble.  Exposed  to  a  great 
heat  it  fuses ;  and  on  cooling,  a  white  opaque,  mass  is  formed  called  the 
sal  prunelle.  When  thrown  on  burning  coals,  nitre  deflagrates  with 
bright  scintillations. 

Impurities. — Common  salt.     Detected  by  nitrate  of  silver. 

Effects. — These  differ  according  to  the  quantity  in  which  it  is  taken. 
In  moderate  doses,  if  it  be  swallowed  immediately  after  it  has  been  dis- 
solved in  water,  a  sensation  of  coolness  is  experienced  in  the  fauces, 
oesophagus,  and  stomach.  After  continuing  for  a  few  minutes,  this  is 
followed  by  a  sense  of  heat  and  dryness  in  the  parts  where  the  coolness 
was  felt.  According  to  Jorg,  this  is  accompanied  with  thirst  and  an 
increase  of  appetite.*  On  the  bowels  its  operation  is  uncertain,  some- 
times causing  uneasiness,  griping,  and  evacuations,  while  at  other  times 

*  American  Jour.  v.  x.  p.  144. 


DIUEETICS.  287 

it  co iisl.ii i;it,cs.     According  to  the  observations  of  Jorg,  it  also  increa  ' 
tin;  exhalation  from  the  skin,  although   this  is  by  no  meats  u  uniform 
effect.    Jt  is  on  the  urinary  organs  that  the  principal  action  of  nitre  i 

developed. 

On  these  it  acts  as  an  exciiant,  promoting  in  a  remarkable  manner  the 

secretion  of  urine  and  changing  its  quality.  II'  the  urine  be  examined 
while  under  its  use,  the  presence  of  the  nitre  may  be  readily  detected 
It  is  in  consequence  of  this,  no  doubt,  that  its  prolonged  use  proves  irri- 
tative to  those  organs.  For  the  purpose  of  ascertaining  the  effeel  on  the 
circulation,  several  experiments  were  instituted  by  Dr.  Alexander,  of 
Edinburgh.  In  one  he  took  a  drachm  of  nitre  dissolved  in  an  ounce  of 
water,  his  pulse  beating  at  seventy-two  in  the  minute.  Two  minutes 
after  this,  it  was  reduced  to  sixty-four  ;  in  four  minutes  after  to  sixty-two. 
From  this  time  it  began  to  increase,  till  at  the  end  often  minutes  it  was 
at  seventy,  and  soon  after  at  seventy-two,  where  it  remained.  In  about 
one  hour  after  he  repeated  the  same  dose,  his  pulse  beating  seventy  in  a 
minute.  In  one  minute  after  it  was  reduced  to  sixty.  It  soon  rose, 
however,  and  in  teu  minutes  beat  sixty-eight,  and  in  a  few  minutes  more 
seventy.*  Other  experiments  of  a  similar  nature  were -made,  and  with 
a  like  result.  In  all  the  pulse  fell  shortly  after  swallowing  it,  but  in 
about  ten  minutes  rose  again  to  its  original  standard.  From  the  pecu- 
liar manner  in  which  the  pulse  was  affected  in  these  cases,  he  was  induced 
to  believe  that  the  sudden  sinking  of  it  was  entirely  owing  to  the  impres- 
sion of  the  cold  fluid  upon  the  stomach.  In  corroboration  of  this,  he 
found  that  large  draughts  of  simple  cold  water  hastily  swallowed,  always 
lessened  the  number  of  pulsations  in  a  minute,  three,  four,  five,  some- 
times more  beats.f  It  would  seem  that  diminution  of  the  pulse  is  pro- 
duced only  in  consequence  of  the  sudden  impression  of  the  cold  mixture 
on  the  stomach  sympathetically  impairing  the  action  of  the  heart,  and 
not  to  any  specific  operation  of  the  nitre.  During  the  use  of  nitre,  the 
blood  itself  appears  to  undergo  some  change.  Barbier  states  that  in  a 
person  who  took  half  an  ounce  in  the  course  of  four  days,  the  venous 
blood  assumed  a  singularly  lively  red  appearance.^ 

By  some  writers,  nitre  is  supposed  to  be  refrigerant,  and  so  it  would 
seem  to  be,  if  any  inference  can  be  drawn  from  the  sensation  of  cold 
produced  after  swallowing  it,  as  well  as  from  the  depression  of  pulse 
which  it  occasions.  By  Dr.  Alexander,  however,  it  was  ascertained  that 
a  thermometer  placed  on  the  pit  of  the  stomach  was  not  affected  during 
its  use,  and  he  lays  it  down  as  proved,  that  "  whatever  power  nitre 
might  have  of  cooling  the  body,  it  does  not  exert  it  in  any  perceptible 
manner  on  its  external  parts."§ 


*  Experimental  Essays,  by  W.  Alexander,  p.  104,  5.  f  P.  122. 

X  Vol.  iii.  p.  569.     See  also  Stevens's  Exps.  on  this.  §  P.  105. 


238  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

In  large  doses,  as  one  or  two  ounces,  it  acts  as  an  irritant  poison,  caus- 
ing pain  in  the  stomach  and  bowels,  vomiting,  purging,  with  bloody  dis- 
charges, followed  by  vertigo,  delirium,  and  death.  On  dissection  the 
stomach  and  bowels  are  found  inflamed. 

Extent  to  which  Nitre  may  he  taken. — On  this  subject  some  interest- 
ing experiments  were  made  by  Dr.  Alexander,  the  result  of  which  was, 
that  it  might  be  taken  with  perfect  safety  in  much  larger  doses  than  are 
commonly  prescribed.  By  him,  3  iss  dissolved  in  3  iij  of  water,  and 
suffered  to  stand  for  twelve  hours,  was  taken  at  a  dose  without  any  in- 
convenience, and  3  iss  dissolved  in  three  pounds  of  water  was  taken  in 
twenty-four  hours,  a  draught  each  hour,  without  any  unpleasant  effects.* 
A  remarkable  difference,  however,  was  observed  in  the  effects  according 
as  it  was  swallowed  immediately  after  it  was  dissolved,  or  after  it  had 
been  suffered  to  stand  for  a  few  hours.  When  each  dose  was  taken  as 
soon  as  it  was  dissolved,  not  more  than  half  the  quantity  could  be  borne 
without  unpleasant  consequences.f  Dr.  Alexander  states  that  in  a  num- 
ber of  inflammatory  cases,  he  gave  it  to  the  extent  of  ±)  ij  every  hour,  or 
every  hour  and  a  half,  every  dose  being  newly  dissolved.  "  In  this 
way,"  he  says,  "  I  have  generally  seen  it  sit  very  easy  on  the  stomach  ; 
often  procure  great  remission  of  the  symptoms ;  and  almost  always 
wrork  off  by  a  plentiful  discharge  of  sweat  or  urine,  according  as  the 
patient  took  along  with  it  warm  or  cold  drink."J  By  Dr.  Brockelsby, 
it  was  also  used  in  large  doses ;  3  x  in  twenty-four  hours  with  great 
advantage. 

Mode  of  Administration. — The  ordinary  dose  for  an  adult  is  from  10 
to  20  or  30  grs.  repeated  every  two  or  three  hours.  This  may  be  given 
in  water  or  some  mucilaginous  fluid  ;  where  the  object  is  to  produce  its 
refrigerant  effect,  it  should  be  taken  in  cold  water  and  swallowed  as 
soon  as  dissolved.  [This  is  one  of  the  salts  of  which  large  dilution  is 
most  important.  Large  doses  (  3  i  to  3  iss  in  a  day  in  two  quarts  of 
water  or  some  bland  fluid)  of  nitre  have  been  of  late  used  with  great 
success  in  cases  of  rheumatism.  It  often  produces  very  free  diuresis 
and  increases  the  quantity  of  solid  matter  in  the  urine. — Ed.] 


CREAM    OF    TARTAR. 

This  salt  has  been  already  described  under  the  head  of  cathartics ;  it 
is  also  refrigerant  and  diuretic.  If  long  continued,  debilitating  in  its 
operation,  causing  general  emaciation. 

The  best  mode  of  using  it  is —  3  ij  dissolved  in  a  quart  of  water,  to  be 

*  P.  111-113.  f  P.  115.  %  P.  111. 


DIUUKTK  S.  230 

taken  during  the  day,  |w_eetened  with  sugar.     A  weaker  solution  would 
probably  prove  still  more  CBTtatfTly  diuretic. 


ACETATE  OK  POTASH SAL  ])H  i  BTK  I  . 

This  is  prepared  by  saturating  diluted  acetic  acid  with  carbonate  of 
potash  and  then  evaporating.  It  is  a  colorless  salt,  with  a  pungent 
saline  taste,  exceedingly  deliquescent;  when  exposed  t<>  the  air  it  is 
changed  into  a  liquid  of  an  oleaginous  appearance ;  soluble  in  ball'  it- 
weight  of  water  and  twice  its  weight  of  alcohol. 

In  small  doses  diuretic,  and  in  larger  ones  cathartic.  As  a  diuretic 
the  dose  is  from  3 j  to  3  j ;  cathartic  3  i j  to  3  iij — given  in  solution,  vary- 
ing in  strength  according  as  one  or  the  other  effect  is  desired.  [This  is 
one  of  the  best  of  Golding  Bird's  depurative  diuretics,  and  as  such,  may 
be  given  with  the  best  effects  in  rheumatism,  in  fever,  and  other  diseases, 
always  largely  diluted  so  that  it  may  be  absorbed  and  act  on  the  kid- 
neys.— If  it  purge  it  is  not,  as  a  general  rule,  absorbed.] 

Spiritus  nitri  dulcts,  also  called  Spiritus  etheris  nitrosi,  spiritus 
etheris  nitrici,  spirit  of  nitric  ether,  sweet  spirits  of  nitre. — It  is  made  by 
the  action  of  alcohol  upon  nitric  acid.  It  is  a  colorless  liquid,  has  a  fra- 
grant odor  and  a  slightly  sweetish  and  acidulous  taste.  Its  specific 
gravity  should  not  exceed  0.S34.  It  is  inflammable  and  very  volatile. 
It  is  soluble  both  in  water  and  alcohol ;  when  added  to  the  tincture  of 
guaiac  it  has  the  singular  property  of  producing  a  deep  blue  color. 

Effects  on  the  System. — Spirits  of  nitre  acts  decidedly  upon  the  kid- 
neys and  promotes  very  considerably  the  flow  of  urine.  It  is  also  refri- 
gerant and  somewhat  antispasmodic.  It  is  therefore  an  exceedingly 
useful  article  when  you  wish  to  allay  thirst,  moderate  heat,  and  promote 
the  urinary  secretion.  It  is  grateful  to  the  stomach,  relieving  nausea 
and  flatulency. 

Dose. — It  may  be  given  in  doses  of  from  30  to  60  drops  repeated 
every  three  or  four  hours  or  oftener.  [A  few  drops  taken  in  parsley  tea 
is  an  excellent  diuretic  for  infants.] 


DIGITALIS    PURPUREA. 

This  is  the  Foxglove,  a  beautiful  biennial  plant  found  native  in  various 
parts  of  Europe.  In  Great  Britain  it  is  indigenous,  and  in  the  north  of 
England  it  grows  abundantly,  and  presents  a  magnificent  appearance 
about  the  hills  and  the  borders  of  fields.  It  is  generally  found  in  dry 
and  sandy  soils.  In  the  United  States  it  is  also  found  in  abundance,  but 
is  not  indigenous.     It  is  cultivated  here  for  the  beauty  of  its  flowers  and 


240  MATEEIA   MEDICA   AND   THEEAPEUTICS. 

for  medicinal  purposes.  In  the  East  Indies  it  is  also  cultivated.  Mr. 
Ainslie  states  that  lie  saw  it  growing  in  the  botanical  garden  at  Banga- 
lore, although  the  plant  was  not  robust.*  It  has  a  knotty  fibrous 
(perennial)  root,  which  sends  up  a  stem  about  four  feet  high,  Its  flow- 
ers are  numerous  and  beautiful.  They  are  large  and  of  a  bell  form. 
From  their  resemblance  to  the  finger  of  a  glove,  the  name  digitalis  is 
supposed  to  be  derived.  They  are  of  a  bright  purple  color,  sprinkled 
with  eye-like  spots.     The  parts  used  in  medicine  are  the  leaves. 

Physical  Character  of  the  Leaves. — The  leaves  of  the  digitalis  differ 
from  one  another  in  size  and  shape.  The  lower  ones  are  egg-shaped, 
and  about  eight  inches  long  and  three  in  breadth.  Both  are  slightly 
serrated  and  have  wrinkled  surfaces,  the  upper  of  a  dark  green  color 
and  the  under  pale  and  downy.  While  fresh  they  have  no  smell,  but 
on  being  dried  they  acquire  a  slight  narcotic  odor.  Their  taste  is  bitter 
and  nauseous.     Their  powder  is  of  a  beautiful  deep  green  color. 

Chemical  Compositim~ancT  Properties. — Digitalis  imparts  its  active 
properties  both  to  water  and  alcohol.  Its  active  principle  has  been 
isotated  as  a  crystalline  resinous  matter,  bitter,  acrid,  soluble  in  alcohol, 
and  sparingly  so  in  water  and  ether.     It  has  not  been  used  in  medicine. 

Physiological  Effects. — These  vary  very  greatly  with  the  dose  in 
which  it  is  given,  and  the  length  of  time  it  is  continued. 

When  given  in  very  small  doses,  it  does  not  produce  any  very  marked 
effect  on  the  system. 

Given  in  closes  sufficient  to  bring  the  system  under  its  influence,  it 
operates  first  as  an  excitant,  and  afterwards  as  a  sedative.  The  primary 
effects  are  a  sense  of  weight  in  the  head,  vertigo,  headache,  increased 
heat  of  surface,  and  obscured  vision.  Along  with  these,  there  is  a  sense 
of  heat  and  itching  in  the  pharynx  and  oesophagus,  extending  sometimes 
to  the  larynx  and  trachea.  Nausea  and  purging  sometimes  take  place. 
The  kidneys  are  excited,  and  an  increased  secretion  of  urine  results. 
According  to  Jorg,  too,  the  genital  organs  are  excited,  and  "  in  the 
female,  symptoms  identical  with  those  which  precede  the  menstrual 
flux"  are  produced.  On  the  pulse,  the  primary  effect  is  to  increase  its 
force  and  frequency.  On  this  point  there  has  been  much  difference  of 
opinion,  it  being  contended  by  some  that  digitalis  acts  primarily  as  a 
sedative  upon  the  circulation.  That  such,  however,  is  not  the  case  is 
proved  by  abundant  observations.  So  long  ago  as  the  year  1800,  a 
series  of  experiments  were  made  by  Dr.  John  Moore,  which  conclusively 
establish  this  point.  From  one  and  a  half  to  four  grains  of  digitalis  were 
taken  by  himself  and  others,  and  as  a  general  result,  the  pulse  increased 
in  force  and  frequency  during  from  half  an  hour  to  an  hour. 

The  primary  stimulant  effect  thus  produced  is  succeeded  by  a  sedative 

*  Ainslie,  Mat.  Med.,  pref.  p.  21. 


DIURETICS.  241 

influence  manifested  more  especially  in  the  circulation.     After  the  sti- 

iiinliint  action  has  passed  oil',  both  tJj<:  force  aii'l    frequency  of  the   pwl-c 

are  lessened  sometimes  in  a  most,  remarkable  manner. 

This  is  especially  observed  when  the  use  of  digitalis  has  been  con- 
tinued for  a  certain  length  of  lime.  Under  these  circumstances,  the 
pulse  frequently  comes  down  from  100  and  upwards  to  80,  "70,  and  even 
40  and  30  in  a  minute,  and  tins  effect  continues  for  several  days,  and 
even  weeks.  With  regard  to  the  effect  on  the  circulation,  there  is  a 
circumstance  which  has  been  noticed,  which  is  of  practical  interest :  that 
it  varies  with  the  position  of  the  patient.  Although  observed  previously, 
Dr.  Baildon  has  the  credit  of  first  noting  this  curious  fact,  lie  observed 
it  in  his  own  case  while  taking  the  medicine  for  what  he  supposed  to  be 
pulmonary  consumption.  After  the  digitalis  had  produced  its  full  effect 
on  his  system,  as  indicated  by  the  reduction  of  the  pulse  to  about  40  beats 
in  the  minute,  he  found  that  "his  pulse  was  not  lessened  in  frequency 
when  he  stood  erect;  it  was  then  upwards  of  100.  When  he  sat  down 
it  fell  considerably;  when  lying  on  his  back  it  fell  much  more.  Thus, 
during  the  time  it  was  at  40  when  lying,  it  was  about  75  when  sitting, 
and  above  100  when  standing.  This  was  invariably  the  case."  The 
same  fact  he  observed  in  patients  to  whom  lie  gave  it  to  any  extent. 
The  necessity  of  attending  to  this  circumstance  in  the  use  of  this  drug 
is  self-evident. 

[Digitalis  is  a  type  of  the  "  aqueous  diuretics"  of  Dr.  G.  Bird.  It 
increases  the  quantity  of  water  discharged  by  the  urine,  but  not  aug- 
menting the  solids  in  the  urine,  does  not  at  all  affect  the  metamorphosis 
of  tissues  or  aid  in  depurating  the  blood.] 

With  regard  to  the  effects  of  digitalis,  there  is  this  peculiarity  :  they 
are  not  limited  to  the  period  during  which  the  article  is  used,  but  con- 
tinue for  three,  four,  and  five  days  and  even  longer  after  its  use  is  relin- 
quished. Dr.  Baildon  states  that  when  he  took  digitalis  in  his  own  case 
for  phthisis,  after  his  pulse  sank  to  36  he  discontinued  its  use,  but  that 
it  took  nearly  one  month  before  it  returned  to  its  natural  standard,  *72. 
So  also  the  increased  secretion  of  urine  will  be  continued  for  several 
days  after  the  medicine  is  stopped.  In  relation  to  the  sickness  at 
stomach  which  it  produces,  it  frequently  does  not  come  on  until  some 
time  after  the  exhibition  of  the  medicine  has  been  discontinued.  After 
ceasing,  too,  "  it  will  recur  as  violently  as  before,  and  will  continue  by 
repeated  attacks  in  this  manner  for  three  or  four  days,  at  distant  and 
more  distant  intervals."* 

In  large  doses,  or  if  its  use  be  continued  too  long  even  in  ordinary 
doses,  digitalis  produces  the  effect  of  a  narcotico-acrid  poison.  When 
long  continued,  it  sometimes  accumulates  in  the  system  and  eventually 

*  Duncan's  Med.  Com.,  voL  v.  p.  371. 


242  MATERIA    MEDICA    AND   THERAPEUTICS. 

gives  rise,  rather  suddenly,  to  vertigo,  impaired  vision,  nausea,  saliva- 
tion, vomiting  and  sometimes  purging,  copious  perspiration  and  very- 
free  diuresis,  accompanied  with  great  prostration  and  sinking  of  the 
pulse.  If  the  symptoms  are  not  relieved,  general  prostration,  convul- 
sions', and  death  result.  [This  does  not  occur  as  often  as  the  remarks 
of  good  authors  would  lead  us  to  anticipate.  Dr.  Holland  (Medical 
Notes)  says,  that  after  a  rather  extensive  use  of  digitalis  he  has  never 
seen  ill  effects  from  it.] 

From  the  foregoing,  then,  it  appears  that  digitalis  in  its  primary  ope- 
ration is  exciting,  while  its  secondary  action  is  sedative,  and  that  it 
developes  its  principal  powers  upon  the  circulation  and  upon  the  urinary 
oro-ans.  The  proper  indications  for  its  use  are  those  conditions  of  the 
system  in  which  it  is  desirable  to  impair  the  action  of  the  heart,  or  to 
excite  powerfully  the  urinary  secretion. 

Circumstances  Modifying  the  Effects  of  Digitalis. — As  the  result  of 
observation  and  experience,  it  has  been  ascertained  that  the  activity  of 
digitalis  is  a  good  deal  modified  by  a  variety  of  circumstances,  such  as 
the  mode  in  which  the  plant  grows — the  season  of  the  year  when  the 
leaves  are  gathered — the  part  of  the  leaf  that  is  used — the  manner  in 
which  it  is  dried,  and  the  length  of  time  it  is  kept.  By  some  it  has 
been  supposed  that  the  virtue  of  the  digitalis  became  deteriorated  by 
cultivation.  By  Dr.  Hamilton,  however,  the  contrary  is  asserted,  and 
he  states  as  the  result  of  observation  that  when  carefully  cultivated  in 
gardens  where  there  is  a  free  exposure  to  the  air,  it  yields  a  larger  and 
more  vigorous  leaf  than  it  does  in  shaded  lanes  and  hedge  rows  where 
it  is  found  growing  spontaneously.*  The  season  of  the  year  when  the 
leaf  is  gathered  is  of  still  greater  importance.  It  is  well  known  that  in 
vegetables,  the  strength  of  particular  parts  varies  with  the  season,  de- 
pending upon  the  evolution  and  rising  of  the  sap.  In  the  spring  before 
the  sap  has  ascended,  the  principal  power  is  in  the  root,  and  it  is  not 
until  some  time  afterwards  that  this  power  is  imparted  to  the  leaves. 
Different  seasons,  therefore,  are  appropriated  to  gathering,  according  to 
the  part  of  the  plant  which  may  be  used.  In  the  present  case  the  pro- 
per period,  according  to  Dr.  Withering,  is  "  about  the  time  the  flower- 
ing stem  has  shot  up,  and  when  the  blossoms  are  coming  forth."  It  is 
then  that  the  leaf  possesses  the  greatest  strength.  Not  unfrequently, 
by  those  who  deal  in  this  article,  this  rule  is  altogether  disregarded, 
and  the  leaves  are  gathered  very  late  in  the  summer  or  in  the  autumn. 
The  difference  in  power  and  effect  may  easily  be  imagined.  By  Dr. 
Withering,  who  studied  and  understood  this  vegetable  more  thoroughly 
than  any  other  person,  the  small  leaves  are  considered  more  powerful 

*  Observations  on  the  Preparation,  Utility,  and  Administration  of  the  Digitalis. 
Prepared  by  Wm.  Hamilton,  MD.,  p.  18. 


I.IUKKTJCK.  248 

than  the  large,  ami  lie  directs  only  the  leafy  pari  to  be  used  the  stalk 
and  middle  being  rejected.  In  drying  the  leaves  for  preservation,  great 
care  is  to  be  taken.    They  should  be  dried  separately  in  the  air  or  in  a 

tin  pan  before  tlie  fire,  with  a  heat  just  suflicicnt  to  allow  of  their  reduc- 
tion to  powder.  If  it  be  possible,  it  should  be  done  with  the* exclusion 
of  light.  Both  light  and  great  heat  have  a  tendency  to  impair  their 
virtues.  After  drying  they  should  be  kept  in  opaque  vessels,  i  eluded 
from  light  and  moisture,  or  they  may  be  pulverized  and  kept  in  the 
same  kind  of  vessels.  The  best  plan  is  to  have  digitalis  fresh  every 
year. 

PRACTICAL    APPLICATION. 

1.  Inflammation. — From  the  very  decided  effect  which  digitalis  has 
in  lowering  the  force  and  frequency  of  the  pulse,  it  was  very  natural  to 
suppose  that  it  might  prove  exceedingly  advantageous  as  a  remedy  in 
controlling  inflammatory  action.  Experience,  however,  has  satisfac- 
torily established  the  fact  that  in  the  primary  stages  of  inflammation  it 
is  not  to  be  depended  upon.  After  suitable  depletion,  it  may  prove  a 
useful  auxiliary  by  quieting  the  irritation  of  the  heart. 

2.  Hemorrhages. — Here  too  much  was  expected  from  digitalis,  but 
experience  has  proved  that  the  remedy,  though  not  without  power,  is 
not  adequate  to  the  control  of  active  hemorrhage,  and  as  has  been  sug- 
gested by  Mr.  Brodie,  its  use  is  not  without  danger. 

3.  Pulmonary  Consumption. — So  great  were  the  advantages  sup- 
posed at  one  time  to  result  from  the  use  of  digitalis  in  pulmonary  con- 
sumption, that  its  ardent  advocates  were  ready  to  proclaim  it  a  specific 
for  that  formidable  disease.  Time  has  dissipated  this  fond  anticipation, 
and  proved  that  though  digitalis  will  do  something  in  this  complaint,  it 
falls  far  short  of  being  a  specific.  To  moderate  the  action  of  the  heart, 
and  diminish  the  general  irritability  of  the  system,  may  alleviate  the 
unpleasant  symptoms  of  tuberculous  deposit  in  the  lungs.  This  is  all 
that  digitalis  can  do. 

4.  Dropsy. — In  this  disease  digitalis  has  been  more  celebrated  than  any 
other,  and  it  is  no  doubt  a  remedy  of  great  value.  It  is  not  appropriate 
to  every  form  of  the  disease,  nor  to  every  state  and  condition  of  the 
system.  As  a  general  rule  it  will  succeed  best  in  asthenic  rather  than 
sthenic  dropsies ;  but  its  best  powers  in  dropsy  are  manifested  in  those 
cases  where  the  effusion  is  consequent  on  organic  disease  of  the  heart ; 
here  by  quieting  the  circulation  it  diminishes  exhalation,  while  by  its 
stimulating  effect  on  the  kidneys  it  moves  the  fluid. 

Diseases  of  the  Heart  and  great  vessels. — In  many  of  these  affections 
a  great  deal  can  be  done  by  the  steady  use  of  digitalis.  It  moderates 
the  force  of  circulation,  and  thus  probably  delays  the  progress  of  aneu- 


244  MATERIA  MEDIC  A   AND   THERAPEUTICS. 

risms  in  very  many  cases,  while  in  a  few  by  favoring  coagulation  of  the 
blood  in  the  sac  it  may  promote  a  cure.  In  very  many  functional  dis- 
orders of  the  heart  digitalis  will,  by  moderating  the  force  of  the  circula- 
tion, afford  temporary  if  not  permanent  relief. 

Modes  of  Administration. —  Substance. — In  this  state  it  may  be  given 
either  xapill  or  powder  ;  do9e,  to  begin  with,  from  gr.  ss  to  gr.  j  twice  a 
day  to  be  increased  gradually  by  the  addition  of  J  of  a  gr.  a  day,  or  the 
original  dose  to  be  repeated  at  shorter  intervals,  say  of  six  or  eight  hours. 
In  using  the  digitalis  in  substance,  great  care  should  be  taken  to  see  that 
it  has  the  green  color  and  the  peculiar  smell  of  the  fresh  plant ;  other- 
wise there  is  no  certainty  in  its  operation. 

Infusion. — This  a  more  common  form  than  the  substance,  and  is 
prepared  by  infusing  3  j  of  the  dried  leaves  for  four  hours  in  half  a  pint 
of  boiling  water.  To  th"Ts*when  strained  |  j  of  any  aromatic  spirit  is  to 
be  added  to  preserve  it  from  spoiling.  Of  this  from  3  ss  to  §  j  may  be 
taken  twice  a  day.  In  this  form  it  has  generally  been  supposed  that  the 
digitalis  operates  more  powerfully  and  successfully  as  a  diuretic,  and  it  is 
accordingly  in  this  way  that  it  has  been  customary  to  prescribe  it  when 
administered  in  dropsical  affections. 

Tincture. — Of  all  the  preparations,  this  for  general  use  is  the  most 
valuable.  It  is  the  form  in  which  it  is  generally  prescribed  to  produce 
the  specific  effect  of  the  article  on  the  circulation.  As  a  diuretic,  it  is 
inferior  to  the  infusion.  The  dose  of  the  tincture  to  begin  with,  is  from 
ten  to  twenty  drops  twice  a  day,  to  be  increased  gradually  a  drop  or  two 
a  day  until  the  desired  effect  on  the  pulse  is  produced. 

RULES  TO  BE  OBSERVED  IN  THE  USE  OF  THIS  ARTICLE. 

From  the  very  powerful  and  peculiar  effects  which  digitalis  produces 
on  the  system,  too  much  caution  cannot  be  observed  in  its  exhibition. 
For  the  purpose  of  guiding  you  a  little  on  this  subject  the  following  rules 
may  be  observed. 

1.  See  that  the  article  is  really  what  it  professes  to  be  and  ascertain 
as  far  as  you  can  the  strength  of  the  preparation,  wdiether  it  is  in  the 
form  of  powder  or  tincture.  From  what  has  been  already  stated  in  rela- 
tion to  the  variable  strength  of  the  leaf,  the  necessity  of  this  precaution 
is  perfectly  obvious. 

With  regard  to  the  tincture,  there  is  still  another  precaution  necessary. 
Not  unfrequently  in  apothecaries'  shops,  it  is  customary  to  leave  tinctures 
upon  the  dregs,  and  gradually  pour  off  the  clear  part  for  use — "  the  dregs 
are  afterwards  pressed  out,  and  the  last  portion  of  the  tincture  acquires, 
by  this  careless  proceeding,  double  the  strength  of  the  first."  In  this 
way  accidents  of  a  serious  nature  have  sometimes  occurred.  Mr.  Brande 
relates  a  case  of  a  person  laboring  under  hydrothorax  who  was  in  the 


DIURETICS.  245 

habit  of  taking  forty  drops  of  the  tincture  of  digitalis  every  night  on 
eroina:  to  bed.  Being  in  the  country  without  his  medicine,  he  wot 
obliged  to  send  to  an  apothecary  there  for  some  of  if,  and  of  tin-  he 
took  the  usual  quantity.  In  the  morning  he  was  dead!  From  the 
symptoms  it  was  suspected  to  be  owing  to  the  medicine,  and  on  inquiry 
it  was  found  that  the  tincture  had  been  kept  standing  on  the  leaves  80 
long  that  at  the  time  it  was  sold,  it  had  evaporated  so  much  as  to  render 
it  necessary  to  shake  out  the  leaves  and  squeeze  them  to  obtain  the 
necessary  quantity.  In  this  case  the  strength  of  the  article  was  so 
greatly  increased  as  to  leave  no  doubt  that  the  patient  died  from  the 
effects  of  the  medicine  and  not  from  disease. 

2.  As  the  effects  of  digitalis  are  obtained  not  from  a  single  dose,  bu1 
from  repeated  doses,  and  as  these  effects  arc  apt  to  be  violent  and  even 
dangerous  if  the  use  of  the  remedy  be  carried  beyond  a  certain  limit,  it 
is  essential  in  all  cases  to  observe  very  carefully  and  repeatedly  the  state 
of  the  patient  while  the  medicine  is  administered.  As  soon  as  any 
effect  is  produced  on  the  pulse,  its  use  is  to  be  intermitted.  By  Dr. 
Withering  the  rule  is  laid  down  that  it  should  be  continued  until  "it 
either  acts  upon  the  kidneys,  the  stomach,  the  pulse,  or  the  bowels  ;  but 
let  it  be  stopped  at  the  first  appearance  of  any  of  these  effects."  The 
pulse  should  accordingly  be  incessantly  examined  to  enable  you  to  judge 
of  the  manner  and  extent  of  its  action.  The  reason  for  the  necessity  of 
stopping  the  remedy  as  soon  as  its  effects  begin  to  appear,  is,  that  they 
accumulate  in  the  system,  and  then  there  is  no  proportion  between  them 
and  the  individual  doses  which  may  be  administered. 

3.  Another  precaution  necessary  in  using  it  is  founded  on  the  fact  that 
though  in  persons  who  continue  taking  digitalis  for  any  length  of  time, 
larger  and  larger  closes  may  be  taken  with  impunity,  resembling,  in  this 
respect,  opium ;  yet,  if  the  use  of  it  be  suspended  for  any  length  of 
time  the  effect  of  habit  wears  off  and  the  system  loses  the  power  of 
bearing  such  large  quantities.  If  given,  therefore,  under  these  circum- 
stances, serious  and  even  dangerous  consequences  may  arise.  As  a  pru- 
dential measure,  therefore,  you  are  always  to  commence  agaiu  with 
moderate  doses. 

4.  Dangerous  prostration  has  sometimes  followed  a  sudden  rising  from 
the  chair  or  bed.  Let  your  patient  be  cautioned  against  the  sudden 
assuming  of  the  erect  posture. 

[5.  With  all  the  precautions  that  can  be  taken  it  is  a  very  dangerous 
as  well  as  a  very  uncertain  remedy.  It  proved  fatal  in  one  case,  in  the 
hands  of  the  most  prudent  and  one-of  the  most  skilful  physicians  I  ever 
knew — the  late  Joseph  Parrish,  of  Philadelphia. — Ed.] 


246  MATERIA   MEDIC  A   AND   THERAPEUTICS. 


SCILLA    MARITIMA. 

This  has  already  been  noticed  under  the  head  of  emetics.  As  a 
diuretic,  it  is  still  more  valuable.  To  obtain  its  full  effect  in  this  way  it 
is  necessary,  however,  to  give  it  to  a  certain  extent.  Taken  in  certain 
quantities,  this  article  causes  nausea,  vomiting,  and  purging.  By  Dr. 
Home  of  Edinburgh,  it  was  maintained  that  the  production  of  actual 
vomiting  was  necessary  to  secure  the  full  diuretic  operation  of  it,  and  he 
relates  several  cases  of  dropsy  which  seem  to  support  this  view.  Others 
contend  that  vomiting  interferes  with  its  subsequent  action  as  a  diuretic. 
Whether  actual  vomiting  be  necessary  or  not,  one  thing  is  certain,  that 
some  impression  ought  to  be  made  on  the  stomach  in  the  way  of  nausea, 
before  its  full  effect  will  be  obtained.  The  rule  laid  down  by  Dr.  Black- 
all  is,  perhaps,  the  best ;  carry  it  to  the  fullest  extent  which  the  patient 
can  bear  without  causing  sickness.  To  get  at  this  point,  begin  with 
small  doses,  gradually  increasing  them  until  either  a  suitable  diuretic 
effect  is  produced,  or  until  slight  nausea  is  brought  on.  A  little  less 
than  this  is  then  to  be  continued,  .until  the  desired  effect  is  produced. 
In  its  general  effect  on  the  system,  squill  is  usually  considered  stimulat- 
ing. Yet  it  is  observed  that  when  the  system  is  under  its  full  influ- 
ence, especially  if  nausea  and  vomiting  be  present,  the  pulse  is  ren- 
dered much  slower.  This  is  particularly  remarked  by  Dr.  Home.  In 
some  cases  the  pulse  was  reduced  as  low  as  40. 

Mode  of  Administration. — Substance. — Most  usually  in  the  form  of 
pill ;  from  1  to  3  grs.,  two  or  three  times  a  day,  frequently  combined 
with  calomel. 

Vinegar. — This  is  the  better  form,  inasmuch  as  the  dose  can  be  gra- 
dually increased.  Of  this  about  30  drops  three  times  a  day  may  be 
commenced  with — increase  to  50  or  till  nausea  is  produced. 

Used  in  dropsies  in  which  the  urine  is  not  coagulable  or  where  the 
inflammatory  diathesis  is  not  present. 


convolvulus  panduratus  {the  wild  potatoe). 

An  indigenous  plant  with  a  climbing  stem,  growing  ten  or  twelve  feet 
long.  The  active  part  is  the  root.  This  is  about  three  inches  thick, 
and  two  or  three  feet  long,  branched  at  the  bottom — externally,  whitish 
and  milky,  with  somewhat  of  an  acrid  taste. 

Effects. — Diuretic  and  cathartic.  In  powder  it  purges,  but  does  not 
act  as  a  diuretic.  In  infusion,  according  to  Dr.  McLean,  it  is  one  of  the 
best  diuretics  we  have.  He  recommends  it  to  be  made  by  adding  an 
ounce  of  the  root  cut  into  small  pieces  to  a  pint  of  boiling  water.     Of 


1'irrjRBTICS.  L'17 

this,  tlic  dose  is  |*  sa.  every  two  hours ;  the  addition  of  juniper  berries 
increases  the  effect.  It  does  not  stimulate  the  system,  sits  well  on  iIj' 
stomach,  and  is  very  popular  in  some  parts  of  the  country  in  many  com- 
plaints. 

.IUNIPERUS    COMMUNIS. 

This  is  the  common  juniper,  a  low,  branching  evergreen,  growing  on 
heaths  and  hills.  It  is  a  native_of_Europc,  but  naturalized  in  this  coun- 
try. It  grows  about  six  or  seven  feet  high,  and  if  properly  cultivated, 
fourteen  or  fifteen  feet.  The  parts  used  in  medicine  are  the  Imgies-and 
tops — principally  the  berries.  The  berries  are  about  the  size  of  common 
currants,  and  purplish  black  in  color;  they  have  a  peculiar  aromatic 
tcrebinthinate  odor,  and  a  warm,  sweetish  taste,  followed  by  bitterness. 
The  best  kind  are  imported  into  this  country  from  the  Mediterranean. 
The  berries  produced  in  this  country,  although  equal  in  appearance,  are 
very  inferior  to  the  foreign,  and  are  not  much  used. 

Composition. —  Volatile  oil,  1.00;  wax,  4.00  ;  resin,  10.00;  peculiar 
kind  of  sugar,  with  acetate  aud  malatc  of  lime,  30.80  ;  gum,  7.00  ;  Hgn'm, 
35.00  ;   water,  12.90. 

Both  alcohol  and  water  extract  the  virtues  of  the  berries.  The  active 
properties  of  this  article  depend  upon  the  volatile  oil,  which  is  obtained 
by  distillation. 

Effects. — Acts  decidedly  on  the  urinary  organs,  promotes  the  secre- 
tion of  urine,  and  imparts  to  that  fluid  the  odor  of  violets.  To  the  blad- 
der, it  proves  stimulant  and  tonic,  exerting  a  special  influence  over  its 
muscular  and  mucous  tissues.  Hence,  in  debilitated  states  of  that  organ, 
it  sometimes  restrains  secretion  and  augments  its  contractile  powers. 
Upon  this  principle  it  has  been  found  useful  in  catarrh  of  the  bladder, 
&c,  and  in  some  cases  small  calculi  have  been  expelled  during  its  use. 

If  given  in  large  doses,  it  causes  great  irritation  of  the  urinary  organs. 

On  the  system  at  large,  the  general  effects  of  this  article  are  stimulat- 
ing ;  cordial  to  the  stomach  ;  it  excites  the  circulation,  and  quickens 
the  functions  generally. 

Form  of  Administration. — The  common  form  is  that  of  infusion.  |j 
of  bruised  berries  to  a  pint  of  boiling  water — dose  §juj_to_JJ5^ every 
four  hours. 

Oil  of  Juniper. — Obtained  by  subjecting  the  fruit  to  distillation  with 
water.  Limpid,  transparent,  nearly  colorless,  lighter  than  water,  and 
has  the  odor  and  taste  of  the  fruit. 

This  is  one  of  the  most  powerful  diuretics  we  have.  Dose,  from  two 
to  six  drops  mixed  with  sugar  and  mucilage. 

"Christison  says  that  five  minims  of  the  oil  with  3  j  of  sweet  sp.  of 
nitre,  three  times  a  day  in  any  common  vehicle,  produced  diuresis  in 
dropsy  where  other  means  had  failed. 


248  MATERIA  MEDICA  AND  THERAPEUTICS. 


APOCYNUM  CANNABINUM. 

Indian  Hemp. — An  indigenous  herbaceous  plant,  growing  in  every 
part  of  the  United  States.  It  grows  two  or  three  feet  high,  with  a 
horizontal  .root  five  or  six  feet  long.  Both  the  stem  and  root,  when 
fresh,  abound  in  milky  juice.  The  bark  of  the  stem  isTough  and 
fibrous,  and  can  be  peeled  off  in  strings.  By  the  Indians  it  is  used  as  a 
substitute  for  hemp,  in  making  their  bags  and  fishing  nets,  &c,  and  from 
this  the  common  name  of  Indian  hemp  is  derived.  The  only  part  used 
in  medicine  is  the  root. 

The  root  is  from  five  to  six  feet  long,  and  about  one  third  of  an  inch 
thick.  It  is  composed  of  two  parts,  a  cortical,  brown  and  rough  with- 
out, and  white  and  smooth  within  ;  and  a  ligneous  part,  which  is  a 
cord  of  a  yellowish  white  color.  Its  taste  bitter  and  nauseous,  odor 
strong  and  unpleasant.  When  dried,  the  root  is  brittle  and  readily 
pulverized,  yielding  a  powder  very  much  like  that  of  ipecacuanha. 

Composition. — It  contains  a  peculiar  bitter  principle,  apocynin,  tannin, 
an  acid  (probably  the  gallic),  gum,  resin,  wax,  fecula,  coloring  matter, 
and  lignin.  Both  water  and  alcohol  extract  its  virtues.  Water  does 
it  to  a  greater  extent  than  alcohol.  The  cortical  part  yields  a  much 
larger  proportion  of  active  ingredients  than  the  ligneous. 

Effects. — Resembles  in  many  respects  colchicum.  In  moderate 
doses,  promotes  the  secretions  of  the  mucous  membrane,  acting  as  an 
alterative  and  expectorant.  In  large  doses  it  causes  nausea,  vomiting, 
and  free  purging.  Along  with  these,  it  lowers  the  frequency  of  the 
pulse,  and  increases  the  secretions  from  the  skin  and  kidneys.  Like 
many  other  diuretics,  it  is  by  no  means  certain  in  its  action  on  the 
kidneys ;  in  some  cases  producing  a  free  evacuation  of  urine,  while  in 
others  little  or  no  effect  of  this  kind  is  produced.  In  its  action  on  the 
bowels  it  is  powerfully  hydragogue.  The  powder  applied  to  the  nostrils 
acts  as  a  sternutatory. 

Mode  of  Administration.  Substance. — Fifteen  grains  prove  emetic 
and  operate  very  much  like  ipecac.  If  the  dose  be  large,  it  vomits  and 
purges. 

Decoction. — This  is  the  best  form,  3  ij  of  the  dried  root  boiled  in 
three  pints  of  water  down  to  two  pints  ;  of  this  §  j  to  3  ij  three  times 
a  day,  or  often  er. 

Used  principally  in  dropsy.  The  juice  of  the  root  or  plant  is  used 
as  a  local  application  in  cutaneous  affections. 

Colchicum  autumnale. — Of  this  I  shall  speak  at  large  when  I  come 
to  treat  of  sedatives. 

Turpentine. — This  has  been   already   noticed   under  the    head   of 


DIURETICS.  249 

anthelmintics.  In  large  doses,  it  acts  speedily  and  powerful!]  on  the 
intestines,  and  in  this  way  is  used  for  the  purpose  of  evacuating  the 
tape  worm,  Given  in  small  doses,  it  affects  not  the  bowels,  but  the 
urinary  organs,  exciting  them  to  increased  action  and  promoting  the  How 
of  urine;  occasionally  it  causes  a  good  deal  of  irritation,  sometin 
strangury  and  suppression  of  urine.  Most  generally,  however,  it  merely 
increases  the  flow  of  urine.  Under  its  use,  the  fluid  always  acquires  the 
peculiar  smell  of  violets.  So  decided  is  the  affinity  of  this  substance  for 
themrinary  organs,  that  even  breathing  the  vapor  of  it  for  a  short  time 
imparts  the  same  odor  to  the  urine.  In  its  general  operations  on  the 
system,  this  article  is  stimulating.  Given  in  doses  of  fifteen  to  thirty 
grains,  it  quickens  the"  pulse,  increases  animal  heat,  and  causes  some 
degree  of  exhilaration.  As  a  diuretic,  therefore,  its  use  is  to  be  limited 
to  those  cases  in  which  a  stimulant  is  indicated. 

Besides  increasing  the  flow  of  urine,  "  it  is  said  to  possess  the 
remarkable  property  of  increasing  the  lithic  acid  in  it,  and  it  certainly 
appears  at  times  to  bring  on  lithiasis  in  those  whose  fits  of  gravel  are 
habitually  carried  off"  by  copious  discharges  of  lithic  acid  and  lithate  of 
ammonia." — Christison,  p.  922. 

Although  acting  on  the  urinary  organs,  turpentine  is  not  a  very 
reliable  diuretic. 

Form,  &c. — Ten  to  twenty  or  thirty  drops,  diffused  in  water  with 
mucilage  and  sugar. 

CANTHARIDES. 

A  full  account  of  this  article  will  be  given  under  the  head  of  Epi- 
spastics.  It  is  sometimes  used  internally,  and  its  effects  differ  greatly 
according  to  the  quantity  in  which  it  is  taken. 

In  moderate  doses,  it  acts  as  a  gentle  stimulant  to  the  alimentary 
canal,  and  speedily  produces  a  sense  of  irritation  in  the  urethra,  accom- 
panied with  an  increased  desire  to  pass  urine.  In  some  cases,  the 
quantity  of  urine  is  increased,  in  others  not.  Although,  therefore,  it 
acts  decidedly  on  the  urinary  organs,  it  is  not  uniform  in  its  operation 
as  a  diuretic. 

In  large  doses,  it  produces  great  irritation  of  the  urinary  organs, 
causing  all  the  symptoms  of  strangury.  There  is  pain  and  burning  in 
the  bladder,  with  constant  desire  to  pass  urine.  The  secretion  of  that 
fluid,  instead  of  being  increased,  is  diminished,  while  the  inflammation 
of  the  neck  of  the  bladder  and  urethra  causes  a  constant  desire  to  pass 
it.  In  these  organs,  a  state  of  things  is  brought  about  analogous  to 
that  which  exists  in  the  intestines,  in  cases  of  dysentery.  Along  with 
all  this,  there  is  general  feverish  excitement  of  the  system. 

In  still  larger  doses,  it  acts  as  an  irritating  poison. 


250  MATERIA   MEDICA   AND    THERAPEUTICS. 

According,  therefore,  to  the  manner  in  which  it  is  used,  cantharides 
may  be  made  to  produce  the  effects  of  a  mild  stimulant  or  of  a  power- 
ful irritant  to  the  urinary  organs.  Upon  the  general  system,  it  acts  as 
a  stimulant. 

Form  and  Dose. — Fill  i  to  ij  grs.  Tincture,  ten  |  to  sixty  drops  in 
barley  water  or  gum  water. 

A  very  free  use  of  diluents  is  essential,  while  using  this  article,  both 
to  render  its  diuretic  operation  more  certain,  and  to  prevent  strangury. 


COPAIBA. 

This  is  the  product  of  different  species  of  the  Copaifera,  a  genus  of 
plants  growing  in  the  warm  regions  of  South  America.  The  Copaifera 
officinalis  is  a  lofty  tree  growing  in  Venezuela  and  some  parts  of  the 
West  Indies.  The  greater  part  of  the  copaiba  of  commerce,  however, 
is 'obtained  from  the  Copaifera  multijuga,  a  native  of  the  province  of 
Para,  in  the  Brazils. 

The  balsam  is  obtained  by  boring  or  wounding  the  tree  to  the  pith 
near  the  base  of  the  trunk,  where  it  flows  so  freely  that  twelve  pounds 
have  frequently  been  collected  in  three  hours.  When  it  first  flows,  it  is 
a  clear,  thin,  colorless  fluid  ;  but  by  being  kept,  it  acquires  a  yellowish 
color,  and  becomes  thickened. 

Balsam  of  Copaiba  is  clear  and  transparent,  of  the  consistency  of 
olive  oil,  and  of  a  pale  golden  color.  It  has  a  peculiar  and  fragrant 
odor,  and  an  acrid  bitterish  taste.  It  is  lighter  than  water.  When 
exposed  with  an  extended  surface  to  the  action  of  the  atmosphere,  it 
gradually  thickens  until  it  at  length  becomes  solid,  dry,  and  brittle,  like 
resin.     When  triturated  with  T\  magnesia,  it  gradually  becomes  solid. 

When  copaiba  becomes  very  old,  it  is  susceptible  of  crystallization. 
Pelletier  has  seen  it  thirty  years  old ;  the  resinous  crystals  had  the  pro- 
perty of  polarizing  light.  By  long  keeping,  its  virtues  are  impaired ; 
the  fresher  the  better.  In  ivater  it  is  insoluble ;  in  alcohol,  ether,  and 
the  fixed  and  volatile  oils,  perfectly  soluble. 

Chemical  Composition. — Copaiba  consists  of  volatile  oil  and  resin. 
According  to  the  analysis  of  Stolze,  100  parts  consisted  of  volatile  oil, 
38  parts  ;  yellow  hard  resin  (copaivic  acid),  52.75  ;  broiun  soft  resin, 
1.66  ;  water  and  loss,  */59.     The  active  part  is  the  oil. 

After  copaiba  has  been  deprived  of  its  volatile  oil,  by  distillation,  a 
brownish  resinous  mass  is  left.  This  is  sold  as  the  resin  of  copaiva.  It 
consists  of  the  two  resins  before  mentioned,  which  may  be  separated  by 
rectified  spirit.  This  dissolves  the  acid  resin  (copaivic  acid),  but  leaves 
the  viscid  one. — (Pereira.) 

Parity. — According  to  Dr.  Paris,  a  great  deal  of  the  copaiba  used  in 


DIUKETICS.  251 

London  is  factitious ;  and  he  states  that  a  trial  tool  place  between  the 
owner  of  certain  premises  that  were  burnt  down  and  the  governor  of 
the  Sun  Fire  Office,  in  consequence  of  the  latter  refusing  to  indemnify 
the  proprietor  for  his  loss,  because  the  fire  had  been  occasioned  by  his 
making  balsam  of  copaiba. 

The  articles  with  which  it  is  sometimes  adulterated  are  common  oil, 
Venice  turpentine,  and  cantor  oil.  Of  these,  the  most  difficult  of  detec- 
tion is  castor  oil,  from  the  fact  of  its  being  soluble  in  alcohol  as  well  as 
the  balsam,  which  the  other  oils  are  not. 

To  detect  the  presence  of  castor  oil,  the  following  tests  may  be 
resorted  to. 

1.  Boil  one  drachm  of  the  copaiba  in  a  pint  of  mater  till  the  tirjaid  is 
entirely  evaporated.  If  the  copaiba  be  pure,  a  hard  resinous  mass  is  left 
behind  If  it  contain  castor  oil,  it  will  be  more  or  less  soft,  according 
to  the  quantity  of  oil  present. 

2.  Shake  together  in  a  bottle  one  part  of  aq.  ammonice  with  two  and  a 
half  of  copabia.  If  the  copaiba  be  pure,  the  mixture  will  speedily  become 
clear  and  transparent ;  if  it  contain  castor  oil,  it  will  remain  more  or  less 
opaque. 

The  presence  of  turpentine  may  be  detected  by  the  odor,  when  heated. 
A  simple  way  of  doing  this  is  to  drop  a  little  of  the  suspected  article  on 
a  heated  spatula. 

The  presence  of  common  oil  maybe  detected  by  the  action  of  alcohol. 
Pure  balsam  is  soluble  in  about  four  parts  of  alcohol — common  oils 
are  not. 

It  is  sometimes  mixed  with  rape  oil.  In  this  case  if  dropped  into 
water,  it  will  not  preserve  its  spherical  form  on  the  surface  as  it  will 
if  pure. 

Effects. — Copaiba  is  a  local  and  general  stimulant.  When  taken  into 
the  stomach  it  creates  a  sense  of  warmth,  which  is  followed  frequently 
by  a  general  disturbance  of  that  organ.  Eructations  charged  with  the 
balsam  take  place,  accompanied  with  nausea,  loss  of  appetite,  and  some- 
times vomiting.  These  effects  are  frequently  so  disagreeable  as  to 
prevent  the  continuance  of  it.  The  constitutional  effect  of  the  copaiba 
is  principally  developed  in  its  action  on  the  mucous  membranes,  and 
more  especially  on  the  urinary  organs.  It  excites  the  kidneys,  increases 
the  flow  of  urine,  and  at  the  same  time  exerts  a  peculiar  influence  over 
the  mucous  lining  of  the  bladder,  and  more  especially  of  the  urethra. 
To  the  urine  it  imparts  a  bitter  taste  and  a  peculiar  balsamic  smell, 
different  from  the  violet  smell  produced  by  the  turpentine. 

"When  given  in  too  large  doses,  this  article  irritates  and  disorders  the 
stomach,  causing  heat,  pam,  nausea,  vomiting,  purging,  and  pain  of  the 
bowels.  The  general  system,  too,  becomes  excited,  producing  heat  of 
skin  and  fever;  sometimes  the  nervous  system   is  peculiarly  affected, 

17 


252  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

producing,  according  to  Armstrong,  "  a  sort  of  vibratory  feeling  in  the 
brain,  or  causing  a  febrile  anxiety,  with  a  mental  disturbance  bordering 
on  delirium."  Another  curious  effect  sometimes  follows  its  too  free  use, 
and  tbat  is  an  eruption  somewhat  resembling  the  nettle  rash.  This 
more  commonly  occurs  where  the  stomach  has  been  disordered  by  it, 
sometimes  without  this.  In  some  cases  "  hematuria  andischuria  are 
brought  on  by  it." 

Mode  of  Administration. — As  the  taste  of  this  article  is  exceedingly 
disagreeable,  the  form  in  which  it  is  given  is'  a  matter  of  great  import- 
ance, inasmuch  as  it  frequently  depends  upon  this  whether  it  can  be 
taken  at  all.  The  simplest  and  best  form  of  giving  it,  if  it  can  be  taken, 
is  to  drop  it  on  sugar. 

Another  mode  is  to  give  it  floating  on  water  with  the  addition  of  a 
little  bitter  tincture  to  cover  the  taste. 

None  of  these  answer  so  well,  however,  as  to  incorporate  it  with  muci- 
lage, with  the  addition  of  other  ingredients  to  cover  the  taste. 

Recently  another  mode  of  giving  copaiba  has  been  introduced  in  the 
form  of  gelatine  capsules.  They  are  made  of  a  compound  of  gelatine, 
gum,  and  sugar ;  with  this  the  distended  and  greased  bladder  of  the 
tench  (or  other  small  fish)  is  coated  and  afterwards  the  air  and  membra- 
nous mould  are  withdrawn.  (Pereira.)  Each  of  these  capsules  contains 
about  ten  drops  of  copaiba,  and  the  object  is  to  cover  the  taste  and  smell 
of  it.  When  they  get  into  the  stomach  the  capsule  dissolves  and  the 
balsam  escapes.  When  made  into  pills  with  magnesia  the  masses  not  , 
unfrequently  pass  from  the  bowels  unchanged.  __■;.< 

Oleum  Copaib^e. — The  volatile  oil  is  the  active  part  of  the  copaiba, 
the  resin  being  almost  entirely  inert.  It  is  obtained  by  distillation  from 
the  balsam.  As  first  obtained  it  is  of  a  beautiful  green  color.  By 
redistillation  it  is  colorless.  When  perfectly  pure  it  is  limpid  and  color- 
less ;  volatile  and  inflammable,  with  an  acrid  taste,  and  a  peculiar  aro- 
matic color. 

This  possesses  all  the  active  properties  of  balsam,  and  has  recently 
been  introduced  into  practice.     The  dose  is  from  10  to  20  drops  taken 
on  sugar,  or  made  into  an  emulsion. 
R, .    01.  Copaibae  3  ij 
Gum.  Arabic.  3  ss 
Aq.  Cinnamom.  §  ij 
Syrup.  Simp.  3  iss 
Tinct.  Theb.  3  ss 
Tablespoonful  three  or  four  times  a  day. 

Diseases  in  which  the  Copaiba  is  used. — Copaiba  is  almost  exclusively 
used  in  mucous  inflammations,  especially  gonorrhoea,  for  which  it  has 
long  been  the  remedy.     It  used  to  be  given  only  when  the  disease  had 


DIURETICS.  258 

passed  into  the  chrome  stage,  but  now  is  often  used  and  with  suca 
very  early.  The  free  use  of  saline  purgatives  combined  with  plentiful 
dilution  will  prepare  the  system  for  copaiba  in  a  single  day.  It,  should 
be  given  in  full  doses  for  three  or  four  days,  and  then  In  smaller  for 
about  ;i  week.  ["It  has  less  curative  power  over  gonorrhoea  in  ilie 
female  than  in  the  male." — Ricord,]  Copaiba  is  also  used  by  Bome 
practitioners  in  chrOnic  catarrh  of  the  bladder.  In  old  cases  of  bron- 
chitis it  lias  also  sonic  reputation,  and  may  be  used  in  leueonlio-a  with 
prospect  of  advantage. 


The  plant  which  yields  this  is  the  Piper  cubeba,  a  species  of  pepper 
growing-  native  in  Java,  New  Guinea,  and  the  Isle  of  France.  It  is  a 
climbing  perennial  plant.  The  fruit  is  a  berry  which  grows  in  clusters. 
It  is  this  part  dried  which  is  used  in  medicine.  In  their  appearance 
cubebs  resemble  the  common  black  pepper,  with  the  exception  of  being 
lighter  colored  and  having  small  stalks  attached  to  them.  Within  the 
cortical  part,  which  is  hard,  there  is  a  single  loose  round  seed,  with  a 
black  coat — whitish  and  oleaginous  within.  The  berries  have  an  agree- 
able and  fragrant  odor.  When  chewed  they  have  a  pungent,  aromatic, 
and  slightly  bitter  taste,  leaving  a  sensation  of  coolness  on  the  tongue 
resembling  that  which  is  produced  by  peppermint.  The  powder  is  of  a 
dark  color  and  has  an  oily  appearance. 

Composition. — According  to  Vauquelin,  cubebs  contains,  ].  A  volatile 
oil.  2.  A  resin  resembling  that  of  copaiba.  3.  A  small  quantity  of 
another  colored  resin.  4.  A  colored  gummy  matter.  5.  Extractive.  6. 
Saline  substances. 

According  to  Thomson  the  volatile  oil  resides  chiefly  in  the  nucleus. 

It  is  important  to  recollect  that  when  pulverized  the  cubebs  part  very 
readily  with  the  volatile  oil,  and  then'  active  properties  are  greatly  im- 
paired. To  obviate  this  the  best  plan  is  tdfckeep  them  in  the  state  of 
berry — or  if  pulverized  in  bottles  closely  stopped. 

Purity. — In  the  form  of  beny,  according  to  Dr.  Paris,  it  is  frequently 
mixed  with  "  Turkey  yellow7  berries,"  the  dried  fruit  of  the  Rhamnus 
catharticus  (common  buckthorn).  In  powder  it  is  apt  to  be  adulterated 
with  powdered  pimento  (allspice). 

Effects. — In  their  general  operation  on  the  system  cubebs  resemble 
black  pepper.  In  moderate  doses  they  act  as  a  general  stimulant  to  the 
stomach  and  to  the  system  at  large.  In  too  large  doses  they  cause  pain 
and  heat  in  the  stomach  and  bowels,  followed  by  nausea,  vomiting,  and 
purging ;  the  circulation  is  excited,  skin  hot  and  dry,  and  fever  pro- 
duced. 

They  exert  a  specific  influence  on  the  urinary  organs,  increasing  the 


254  MATERIA   HEDICA   AND   THERAPEUTICS. 

flow  of  urine  and  imparting  to  it  a  peculiar  odor.  When  they  purge 
they  are  said  to  impart  the  same  cool  sensation  to  the  rectum  as  they 
do  to  the  mouth  when  chewed. 

There  are  several  important  consequences  supposed  to  have  resulted 
from  the  use  of  cubebs  which  it  is  well  to  be  acquainted  with. 

If  the  bowels  are  not  kept  freely  open  during  their  use  the  powder 
insinuates  itself  into  the  mass  of  faeces  and  causes  excoriations  of  the 
rectum  or  hemorrhoids.  Urticaria  is  another  effect  which  has  some" 
times  been  produced  by  it.  Pereira  says  that  he  has  known  an  erup- 
tion of  this  kind  suspected  as  being  of  syphilitic  origin.  A  case  is 
related,  by  Mr.  Boughton,  in  the  London  Medical  Gazette,  in  which 
temporary  paralysis  followed  the  use  of  cubebs  in  doses  of  3  ij,  three 
times  a  day.  In  the  first  volume  of  the  Medical  Gazette  Mr.  Brodie 
relates  a  case  in  which  it  was  given  in  chronic  inflammation  of  the 
bladder.  The  irritation  of  the  bladder  produced  by  it  was  so  great 
that  it  tended,  as  he  thinks,  to  hasten  the  patient's  death  ;  and  Dr. 
Thomson  gives  a  case  in  which  the  febrile  irritation  was  so  great  as  to 
endanger  the  life  of  the  patient. 

From  the  foregoing  it  would  seem  that  although  generally  a  safe  re- 
medy, it  ought  not  to  be  used  with  unnecessary  freedom. 

Mode  of  Administration. — Powder. — This  is  the  common  mode  of 
giving  it,  and  the  best  menstruum  is  milk.  The  dose  is  from  3  .ss  to 
3  ij,  in  half  a  tumbler  of  milk,  two  or  three  times  a  day.  To  have  the 
full  effect  it  should  be  freshly  pulverized. 

Tincture. — (  3  v  cubebs  to  lbs.  ij  proof  spirit.)  This  is  a  good  prepa- 
ration, and  may  be  given  in  doses  of  from  3  j  to  3  ij«  [B  Pulv.  pip. 
Cubeb.  3  ij  ;  Sub-nit.  Bismuth,  3  ij  ;  Bi-Carb.  Soda?,  3  j.  M.  Is  one  of 
the  best  helps  to  digestion  I  know  of.    Dose,  5  to  10  gr.  after  each  meal.] 

Oil  op  Cubebs. — This  is  obtained  by  distilling  the  pulverized  cubebs 
with  water.  It  is  a  transparent,  slightly  colored  volatile  oil,  with  a  hot, 
aromatic,  bitter  taste,  and  the  peculiar  odor  of  cubebs. 

This  produces  the  same"ffect  as  the  berry,  and  is  a  good  form  of 
giving  it.  The  dose  to  begin  with,  is  ten  or  twelve  drops  on  sugar  or 
suspended  in  water  by  mucilage. 

apium  petroselinum  (Parsley). 

A  small  plant,  a  native  of  the  north  of  Europe,  but  cultivated  every- 
where in  gardens.  Every  part  of  it  contains  an  essential  oil,  to  which 
it  appears  to  owe  its  virtues^  The  part  used  is  the  root.  This  is  the 
most  powerful  in  its  operation,  yet  every  part  of  the  plant  appears  to 
possess  diuretic  properties. 

Although  a  common  this  is  a  very  valuable  diuretic  in  a  great  num- 
ber of  cases.     It  is  mild  in  its  operation  and  generally  sits  well  on  the 


DIIKKTMS.  255 

stomach.    It  is  admirably  suited  to  those  cases  of  strangury  broughl  on 
by  blisters.     In  the  ordinary  suppressions  of  urine  m   children  it   i 
valuable  article.    To  increase  the  efficacy  of  it  the  Beeds  of  the  water- 
melon are  frequently  added  ;  or  the  sweet  spirits  of  nitre. 

The  form  of  giving  it  is  infusion  made  by  adding  a  pint  of  boiling 
water  to  §  i  of  parsley.  The  recent  rootia  the  most  efficacious — a  ten- 
cupful  of  the  infusion  may  he  taken  every  three  or  four  hours  by  an 
adult. 

Daucus  Carota  [Wild  Carrot). — The  wild  as  well  as  the  cultivated 
carrot  is  officinal,  but  though  formerly  esteemed  a  diuretic  they  have 
lost  their  reputation.  The  root  of  the  common  carrot  is  used  as  a  poul- 
tice to  foul  ulcers,  and  acts  as  a  very  pleasant  stimulant  and  corrective. 

Bucnu. — This  is  the  Hottentot  name  for  several  species  of  plants  lie- 
longing  to  the  genus  JDwspia,  or,  according  to  Willdenow,  to  the  genus 
Barosma.  They  are  shrubs  growing  at  the  Cape  of  Good  Hope,  and 
the  leaves,  when  reduced  to  powder,  have  long  been  used  by  the  natives 
as  a  perfume  to  anoint  their  bodies.  The  part  used  in  medicine  are  the 
leaves.  These  are  collected  from  the  Barosma  crenulata,  the  Barosma 
crenata,  and  the  Barosma  serratifolia,  and  sold  in  the  shops  as  the  Bu- 
chu leaves. 

The  leaves  are  from  half  an  inch  to  an  inch  long,  and  three  or  four 
lines  broad.  They  are  of  a  firm  consistence,  smooth  and  shining,  with 
serrated  edges,  and  of  a  pale  or  yellowish  green  color.  They  have  a 
strong' and  aromatic  odor,  and  a  bitterish  taste,  somewhat  resembling 
that  of  mint.     Their  virtues  are  extracted  both  by  water  and  alcohol. 

Effects. — The  Buchu  leaves  are  aromatic  and  stimulant.  Taken  in- 
ternally, they  give  tone  to  the  digestive  organs,  promoting  the  appetite, 
and  correcting  nausea  and  flatulency.  In  addition  to  this  they  are  dia- 
phoretic and  diuretic. 

Mode  of  Administration. — Powder. — Twenty  to  thirty  grs.  taken  in 
a  little  wine,  two  or  three  times  a  day. 

Infusion. — This  is  the  common  form  of  giving  them.  3  ss  of  buchu 
to  half  a  pint  of  boiling  water.      5  i  to   5  ij,  two  or  three  times  a  day. 

Tincture. —  3  ij  leaves  to  lb.  j  proof  spirits,  macerated  for  seven  days 
and  strained —  3  i  to   3  iv. 

The  diseases  in  which  Buchu  has  been  almost  exclusively  used  are 
those  of  the  urinary  organs.  In  chronic  inflammation  of  the  bladder  it 
frequently  proves  exceedingly  beneficial,  allaying  irritation,  and  check- 
ing excessive  secretion.  In  irritation  of  the  urethra,  in  spasmodic  stric- 
ture, and  affections  of  the  prostate,  it  sometimes  also  does  good.  Like 
all  remedies  of  this  class,  however,  it  is  uncertain  in  its  effects.  As  a 
stimulating  diaphoretic  it  has  also  been  used  with  advantage  in  rheu- 
matism. 


256  MATERIA    MEDICA   AND   THERAPEUTICS. 


ARBUTUS    UVA    URSI. 

This  is  the  bearberry,  and  is  a  small  evergreen  shrnb,  growing  native 
in  the  northern  regions  of  Europe  and  America.  It  also  grows  in  the 
northern  part  of  the  United  States,  particularly  in  New  Jersey.  It  bears 
a  small  round  berry  of  a  red  color.  The  part  used  in  medicine  are  the 
leaves.  They  have  a  bitter,  astringent  taste  ;  when  fresh,  no  smell  ; 
when  dried  and  pulverized,  acquire  the  smell  of  Hyson  tea.  The  pow- 
der is  of  a  light  brown  color,  with  a  greenish  tinge.  The  young  and 
green  leaves  should  only  be  used. 

The  principal  ingredient  in  these  is  the  tannic  acid  ;  so  abundant  is 
it  that  in  Russia  they  are  used  for  tanning.  Besides  this  they  contain 
bitter  extractive,  gum  and  resin,  &c. 

Effects. — The  uva  ursi  is  astringent  and  diuretic  Under  its  use,  the 
urine  becomes  dark-colored,  showing  the  absorption  of  it  into  the  circu- 
lation, and  its  subsequent  elimination  through  the  kidneys.  In  this  way 
it  exerts  a  peculiar  tonic  and  astringent  power  over  the  urinary  organs. 
Upon  this  principle,  it  has  been  used  in  those  cases  in  which  the  coats 
of  the  bladder  are  in  a  relaxed  condition,  accompanied  with  increased 
mucous  secretion  from  them.  In  various  chronic  diseases  of  the  urina- 
ry organs,  it  has  been  used  with  variable  success,  sometimes  doing  a 
good  deal  of  good,  at  other  times  none  at  all.  In  acute  cases,  of  course 
it  is  injurious. 

Form. — Powder,  ±)\  to  3  i  three  times  a  day. 

Decoction. — Best  form,  §  i,  water  §  xx.  Boil  to  pint  and  strain,  3  i 
to  I  ij  three  or  four  times  a  day. 


PYROLA    UMBELLATA CHIMAPHILA    UMBELLATA. 

Known  by  the  common  names  of  pipsissewa,  wintergreen,  rheumatism 
weed,  &c.  It  is  a  beautiful  evergreen,  from  six  to  eight  inches  high, 
found  native  in  the  northern  latitudes  of  Europe,  Asia,  and  America,  and 
abounds  in  every  part  of  the  United  States.  The  whole  of  the  plant 
possesses  active  properties,  but  the  parts  used  are  the  leaves  and  stems. 
The  fresh  leaves,  when  bruised,  have  a  peculiar  odor.  They  have  a  bit- 
ter, astringent,  and  somewhat  sweetish  taste.  The  principal  constituents 
are  bitter  extractive,  tannin,  resin,  and  gum.  Both  water  and  alcohol 
extract  all  its  virtues. 

In  its  effects,  the  pipsissewa  is  very  analogous  to  the  uva  ursi,  being 
tonic,  astringent,  and  diuretic.  Like  that,  too,  it  turns  the  urine  black. 
To  the  stomach,  it  is  a  pleasant  tonic :  it  improves  the  appetite  and  in- 


DIURKTICS.  2.r>7 

creases  tlic  general  strength.     The  diseases  in  which  it,  has  bei 
are  chronic  affections  of  the  urinary  organs,  dropsy,  and  scrofula. 

Form.  Decoction. —  ?  ij  to  three  pints  of  water  boiled  down  to  a  quart. 

A  pint  in  twenty-four  hours. 


PAREIRA    URAVA. 

This  is  the  Cissampclos pareira,  a  plant  growing  on  the  Spanish  Main 
and  in  the  West  India  islands.  It  is  generally  called  Pareira  brava. 
which  means  wild  vine,  from  the  supposed  resemblance  of  the  root  to 
that  of  the  wild  vine.  It  is  a  climbing  shrub,  with  a  large  root,  which 
is  the  part  used  in  medicine. 

This  comes  in  roundish  pieces  from  half  an  inch  to  three  or  four  inches 
in  diameter,  and  from  half  a  foot  to  three  or  four  feet  long,  sometimes 
split  longitudinally.  Externally,  it  has  a  dark  brown  wrinkled  appear- 
ance, and  furrowed  cortex.  Internally,  it  is  of  a  yellowish  grey  color, 
with  concentric  rings;  very  porous  and  easily  split.  It  has  no  smell ; 
taste,  at  first  sweetish,  afterwards  becomes  intensely  bitter  and  aromatic. 
Co7?iposition. — According  to  Feneulle,  it  contains  starch,  soft  resin, 
yellow  bitter  principle,  broivn  coloring  principle,  nitre,  with  various  other 
salts.  More  recently  by  "Wiggers,  a  new  vegetable  alkali  has  been  dis- 
covered, which  he'  calls  cissampelina.  This  is  insoluble  in  water,  solu- 
ble in  ether,  alcohol,  acids,  and  of  an  intense  sweetish  bitterness. 

Effects. — Analogous  in  its  action  to  the  TJva  ursi ;  tonic,  diuretic,  and 
if  used  in  considerable  doses,  aperient.  Although  recently  brought  into 
notice,  it  is  not  a  new  remedy.  It  was  introduced  into  Europe  two  cen- 
turies ago  (1648),  and  gained  great  celebrity  as  a  specific  in  affections 
of  the  urinary  organs.  It  was  even  supposed  capable  of  curing  stone  in 
the  bladder.  After  that  it  fell  into  disuse.  Very  recently  it  has  a»-ain 
been  brought  forward,  especially  by  Sir  Benjamin  Brodie,  who  recom- 
mends it  very  highly  in  chronic  inflammation  of  the  bladder,  and  gives 
it  the  preference  to  Uva  ursi.  Like  all  these  remedies,  however,  it  is 
uncertain  in  its  operation. 

Form  and  Dose.  Infusion  or  Decoction. — The  common  form  is  infu- 
sion. 3  vi — boiling  water  one  pint;  macerate  for  two  hours.  Dose,  5  j 
to  3  iij.  Brodie  boils  half  an  ounce  of  the  root  in  three  pints  of  water 
down  to  one  pint ;  eight  to  twelve  ounces  of  this  to  be  taken  dailv. 

Extract. — Grs.  x  to  xxx.  This  is  generally  added  to  the  infusion  to 
increase  its  strength.  Tinct.  of  Hyosciamus  is  also  added  to  allay  irri- 
tation. 


258  MATERIA   MEDICA   AND   THERAPEUTICS. 


CAHINCA. 

This  is  the  root  of  the  Chiococca  racemosa  or  anguifuga,  a  plant  grow- 
ing in  the  interior  of  the  Brazils.  The  term  cahinca  seems  to  be  de- 
rived from  the  Brazilian  Indians.  It  is  a  vine-like  shrub,  growing  five  or 
six  feet  high,  with  a  root  two  or  three  feet  long  and  about  the  thickness 
of  a  straw  or  quill  or  that  of  the  little  finger ;  of  a  reddish-brown  color 
externally,  with  the  surface  knotty  and  wrinkled.  The  part  used  is  the 
baric  of  the  root,  in  which  all  the  virtues  of  the  article  are  supposed  to 
reside.  This  bark  has  a  bitter  nauseous  taste — is  brittle,  hard,  and  about 
a  line  thick.     The  inner  part  of  the  root  has  no  taste. 

Composition. — According  to  the  analysis  of  Caventon  and  Pelletier, 
it  contains,  first,  a  crystallizable  principle,  in  which  all  the  bitterness  of 
the  bark  resides.  This  is  called  kahincic  acid.  Second,  green  fatty 
matter.  Third,  yellow  coloring  matter.  Fourth,  colored  viscous 
matter.  The  virtues  of  the  article  are  extracted  both  by  water  and 
alcohol. 

They  appear  to  reside  in  the  crystallizable  substance. 

Effects. — Cahinca  is  diuretic  and  tonic,  and  at  the  same  time  acts  on 
the  bowels ;  according  to  the  dose  in  which  it  is  given,  it  operates  as  a 
mild  laxative  or  an  active  purgative.  In  considerable  doses,  it  proves 
emetic  also.  Like  many  other  diuretics  it  is  by  no  means  certain  in  its 
action.  If  it  affect  the  bowels  freely,  its  diuretic  action  is  generally 
slight,  and  vice  versa. 

Form — Decoction. — (  3  ij  to  a  pint  of  water  boiled  half  away.)  One 
or  two  tablespoonfuls  three  or  four  times  a  day. 

Watery  Extract. — This  is  a  good  preparation,  possessing  all  the  virtues 
of  the  article.     Dose. — 10  to  20  grs. 

The  diseases  in  which  it  is  chiefly  used  are  dropsy  and  catarrh  of  the 
bladder. 

Muriated  Tincture  of  Iron. — This  possesses  a  good  deal  of  diuretic 
power,  and,  in  cases  requiring  the  combination  of  tonic  and  astringent 
action  on  the  urinaiy  organs,  answers  a  valuable  purpose.  In  cases  of 
retention  of  urine  from  spasmodic  stricture,  it  frequently  gives  relief.  It 
is  to  be  taken  in  doses  of  ten  drops  every  10  or  15  minutes,  till  relief  is 
obtained.  This  sometimes  does  not  occur  until  nausea  supervenes. 
Also  given  in  chronic  inflammation  of  the  bladder,  gleet,  leucorrhoea, 
the  latter  stages  of  gonorrhoea,  and  in  passive  secretion  from  the  kidneys 
and  bladder.     Dose. — 10  to  20  drops  or  more  in  some  mild  diluent. 

Mercury. — Of  the  general  operation  of  mercury  on  the  system,  a 
very  full  account  has  already  been  given.     Its  action  on  the  whole  secre- 


uiuiumcs.  259 

tory  system  was  tlicn  specially  noticed.  Among  others  it  excitee  into 
increased  action  the  kidneys,  and  in  this  way  increases  the  secretion  of 
urine.    By  most  writers  on  the  materia  medica,  the  diuretic  operation 

of  mercury  is  explained  exclusively  upon  the  principle  of  its  stimulating 
the  absorbents.  Hy  this  means  an  increased  quantity  of  fluid  gets  into 
the  circulation  which  is  afterwards  directed  to  the  urinary  organs.  In 
this  way  the  efficiency  of  mercury  in  dropsy  is  explained.  To  me  thi  i 
does  not  appear  altogether  satisfactory,  inasmuch  as  it  excludes  the 
primary  operation  of  this  article  on  the  kidneys.  In  dropsies,  mercury 
acts  beneficially  in  various  ways.  In  the  first  place,  by  stimulating 
directly  the  kidneys,  in  the  same  way  that  it  stimulates  the  liver.  It 
thus  restores  the  functions  of  these  organs,  which  in  dropsy  are  generally 
impaired.  In  the  second  place,  it  acts  by  restoring  all  the  secretions  of 
the  system,  which  are  all  more  or  less  impaired  in  dropsy.  In  this  way 
exhalation  is  diminished  from  the  surface  yielding  the  dropsical  fluid. 
In  the  third  place  it  acts  by  stimulating  the  absorbents.  In  all  these 
ways  combined  it  acts  in  removing  dropsical  effusions,  and  it  is  for  these 
reasons  that  it  is  so  efficient. 

[If  anasarca  depend  on  obstruction  of  the  portal  circulation  by  diseased 
liver,  mercury,  by  modifying  this  diseased  condition,  may  enable  the 
kidneys  to  do  their  work  better.  It  is  in  such  cases  and  in  this  way 
that  mercurials  cure  dropsy.] 


EMMENAGOGUES. 


This  term  is  applied  to  a  class  of  medicines  "which  is  supposed  to 
possess  the  power  of  promoting  the  menstrual  discharge.  This  class  of 
agents  has  been  the  subject  of  much  difference  of  opinion.  Many- 
practitioners  deny  that  any  article  of  the  materia  medica  possesses  any 
specific  power  to  act  on  this  so  called  uterine  secretion.  That  the  ope- 
ration of  the  supposed  emmenagogues  is  excessively  uncertain,  all  admit. 
Still  there  are  a  few  agents  which  do  increase  the  flow,  and  though  many 
of  them  do  and  all  may  act  indirectly,  yet  practical  convenience  justifies 
us  in  retaining  the  class  that  attention  may  be  directed  more  strongly 
to  their  power,  whether  direct  or  indirect,  specific  or  general,  of  pro- 
moting the  discharge  and  thus  relieving  some  very  common  and  very 
distressing  forms  of  diseases.  Suppression  of  the  menses  may  result 
from  a  variety  of  causes,  and  is  generally,  perhaps  always,  only  a  symp- 
tom of  some  derangement  of  the  general  health,  and  of  course  those 
agents  which  restore  it,  must  do  so  by  acting  on  the  disease  of  which  it 
is  a  symptom.  Hence,  in  varying  states  of  the  system,  bleeding,  acrid 
purges,  stimulating  diuretics,  tonics,  antispasmodics,  each  and  all  may  act 
as  emmenagogues. 

Doubting  whether  we  have  any  article  entitled  to  the  name  of  specific 
emmenagogues,  I  shall  speak  of  the  articles  commonly  included  in  this 
class  under  four  heads. 

Stimulating  diuretics.     Cathartics.     Tonics.     Local  remedies. 

Stimulating  diuretics. — The  modus  operandi  of  these  articles  is  very 
simple;  by  their  local  impression  on  the  bladder  they  stimulate  the 
uterus  by  contiguous  sympathy.  Of  these  the  most  popular  are  certain 
vegetable  infusions,  or  the  volatile  oils  obtained  from  them,  as  rue,  pen-' 
nyroyal,  tansy,  &c.  Their  powers  are  very  commonly  (in  domestic 
practice)  aided  by  giving  with  the  infusion  a  quantity  of  some  ardent 
spirit,  as  gin,  whiskey,  or  the  like.  The  essential  oils  of  these  and  other 
plants  are  also  occasionally  given  as  emmenagogues.  There  is  no  reason 
to  suppose  that  either  the  infusion  or  the  oils  have  any  special  power 
over  the  uterus ;  they  act  as  acrid  and  very  uncertain  stimulants,  and 
the  number  of  cases  in  which  they  can  be  advantageously,  or  even  safely 
used,  is  exceedingly  small. 


KMMKNAfJCKJUKS.  2G1 

There  are  two  stimulating  diuretics  in  common  use  which  deserve 
special  notice,  cantharides  ami  savin.  Of  the  former  I  shall  give  the 
history  when  speaking  of  epipastics;  it  suffices  here  to  say  that,  from 
its  agency  on  the  urinary  organs  of  which  f  have  already  spoken,  i 
cially  when  it  produces  strangury,  it  may,  by  transmitting  its  irritation 
from  the  neck  of  tlic  bladder  to  the  uterus,  stimulate  that  organ,  and 
sometimes  bring  on  the  menstrual  discharge.  It  is  generally  given  in 
tincture,  of  which  twenty  drops  twice  a  day  is  a  good  dose  to  begin  with  ; 
it  may  be  increased  till  some  symptoms  of  strangury  appear,  when  it 
should  be  stopped  and  diluents  given  to  relieve  the  bladder.  It  is 
appropriate  only  to  those  cases  where  suppression  occurs  in  dull  leuco- 
phlegmatic  girls.  To  the  nervous,  the  irritable,  the  sanguine,  it  can  do 
nothing  but  barm. 


savin  (junipcrus  sabina). 

This  is  an  evergreen  shrub,  growing  in  the  south  of  France,  also  in 
Canada;  it  rises  to  about  the  height  of  three  or  four  feet.  The  stem  lias 
a  brownish  bark ;  the  leaves,  the  part  used  in  medicine,  are  small  and 
bright  green.  They  have  a  strong,  disagreeable  odor,  and  a  hot,  bitter, 
acrid  taste.  Their  active  principles  are  given  up  to  both  water  and 
alcohol ;  to  the  latter  in  the  greater  quantity.  They  contain  a  large 
amount  of  an  odorous  acrid  oil,  which  is  obtained  by  distillation  with 
water.     Nearly  fifteen  per  cent,  of  oil  has  been  obtained  from  them. 

Effects  on  the  System. — Savin  is  a  stimulant  whose  action  is  directed 
to  the  pelvic  organs.  It  produces  irritation,  and  sometimes  inflamma- 
tion of  the  rectum,  and  has  frequently  caused  abortion,  for  which  nefa- 
rious purpose  it  is  not  unfrequently  used.  As  an  emmenagogue  it  is 
rarely  used  in  regular  practice,  and  should  only  be  ventured  on  in  cases 
like  those  for  which  cantharides  is  advised — the  phlegmatic,  torpid, 
nnirritable.     To  the  plethoric  it  would  be  and  often  is  poison. 

Mode  of  Administration. — Powder — dose,  ten  to  twenty  grains  three 
times  a  day. 

Infusion  and  Decoction. — Safer  than  the  powder ;  the  oi7,  one  to  five 
drops.     This  is  the  dangerous  preparation. 


GUIACUM. 

The  only  form  in  which  this  is  used  as  an  emmenagogue  is  the  vola- 
tile tincture,  and  this  is  certainly  a  most  valuable,  safe,  and  reliable 
article.  It  is  highly  recommended  by  Dewees,  who  used  it  with  a  con- 
fidence that  he  had  in  very  few  remedies.  It  is  appropriate  to  all 
cases  except  where  excitement  and  plethora  are  very  manifest. 


262  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

Dose. — Thirty  drops  in  a  glass  of  milk  thrice  a  day,  to  be  increased 
till  a  drachm  is  taken.  If  it  purge,  give  a  few  drops  of  laudanum  with 
it;  if,  on  the  contrary,  the  bowels  become  costive,  they  must  be  kept 
soluble  by  aloes. 

Purgatives  that  are  useful  in  Amenorrhea. — Of  these  I  will  only  men- 
tion aloes  as  infinitely  the  most  valuable.  It  should  be  given  during  the 
interval  in  doses  just  sufficient  to  keep  the  bowels  soluble,  but  immedi- 
ately before  the  time  when  the  discharge  should  appear,  a  few  purgative 
doses  may  be  tried. 

Combined  with  guiac  (five  grains  of  each  in  pill),  it  often  produces 
most  excellent  effects. 

Tonics  given  for  Amenorrhea. — Two  different  classes  may  be  used 
under  different  circumstances. 

1.  The  vegetable  tonics,  of  which  caluraba  is  the  best,  may  be  given 
as  stomachics  to  give  tone  to  the  stomach,  and  improve  the  appetite. 

2.  The  ferruginous  tonics,  which  are  appropriate  to  all  those  cases 
where  anemia  and  chlorosis  are  present.  Neither  of  these  classes  of 
tonics  should  be  given  till  the  digestive  organs  are  in  a  healthy  state, 
tongue  clean,  bowels  regular,  secretions  healthy. 

Local  Remedies  useful  in  Amenorrhea. — (a.)  Leeches. — These  ap- 
plied to  the  vulva  have  been  recommended  by  some  with  the  view  of 
determining  the  blood  to  the  uterine  organs,  and  aiding  in  this  way  in 
the  restoration  of  the  menstrual  flux.  They  have  been  supposed  to  be 
particularly  useful  in  cases  where  the  interruption  of  the  menses  has 
been  very  sudden,  occasioned  either  by  exposure  to  cold  or  some  violent 
impression  made  upon  the  system ;  or  in  cases  where  determinations  to 
some  other  organ  or  organs  exist  along  with  the  suppression.  All  this 
may  be  true,  and,  no  doubt,  in  some  cases  they  may  prove  advantageous. 
The  great  objection  to  them  is  the  difficulty  of  getting  patients  to  sub- 
mit to  their  use.  Indeed,  the  indelicacy  attending  the  application  of 
leeches  in  this  way  is  so  great  as  to  prevent  their  being  generally  re- 
sorted to.  A  good  substitute,  and  perhaps  preferable  in  most  cases,  is 
to  apply  them  to  the  inside  of  the  thighs,  and  to  the  ankles.  Indeed, 
by  Laennec,  it  is  asserted  that  in  these  situations  they  produce  quite  as 
great  a  derivative  effect  as  they  do  when  applied  to  the  vulva,  espe- 
cially if  applied  to  the  thighs  and  ankles  at  the  same  time.  Used  in 
this  way  they  may  sometimes  be  resorted  to  with  advantage. 

[I  think  much  more  highly  of  this  remedy — use  it  often  and  usually 
with  good  effect. — Ed.] 

(b.)  Lnjection  of  Aqua  Ammonia  into  the  Vagina. — This  is  an  emme- 
nao-ogue  remedy,  which  was  originally  suggested  a  few  years  since  by 
Lavagna,  and  has  been  attended  with  no  inconsiderable  success.  By 
him,  four  cases  of  amenorrhoea  are  related  as  having  been  cured  in  the 
same  number  of  days  by  injections  of  warm  milk  with  aq.  ammonias  in 


EMMENAGOGUES.  263 

tlie  proportion  of  from  ten  to  twelve  drops  to  the  ounce. — Since  then  it 
has  been  tried  in  this  country,  and  with  success.  Dr.  Hosacfc  relate 
case  of  amenorrhea  of  ten  years'  standing  which  had  resisted  all  the 
oridinary  aloetic  and  mercurial  emmenagogues,  and  which  was  relieved 
by  an  injection  into  tlie  vagina  of  aq.  ammonias  and  rain  water  in  the 
proportion  of  3  »s  to  §  viij.  The  injection  was  repeated  three  time 
day.  It  caused  a  slight  degree  of  irritation,  and  in  about  five  weeks  the 
menses  were  restored.  By  Dr.  Gloninger  of  Pennsylvania  two  cases  of 
a  similar  kind  are  also  related.  In  one,  madder,  polygala  senega,  helle- 
bore, cantbarides,  iron,  aloetics,  and  mercurials  were  all  tried  without 
any  advantage.  After  this,  injections  of  milk  and  ammonia  (ten  drops 
to  the  ounce)  were  given  four  times  a  day.  At  the  expiration  of  eight- 
een days  the  menses  appeared.  In  another  case,  by  the  same  mean-. 
they  were  restored  in  the  course  of  a  couple  of  weeks. — N.  Y.  Med. 
and  Phy.  Jour.,  vol.  iii.  p.  38. 

(c.)  Pediluvia,  Warm  Fomentations,  dtc. — The  efficacy  of  immersing 
the  feet  in  warm  water  has  long  been  known.  It  certainly  has  a  most 
powerful  influence  in  determining  blood  to  the  lower  extremities,  and 
in  this  way  intermediately  to  the  uterine  organs.  In  some  cases  ren- 
dering the  water  stimulating  by  the  addition  of  mustard  has  an  excel- 
lent effect.  Warm  fomentations,  fumigations,  and  the  semi-cupium,  act 
in  the  same  way  by  relaxing  the  vessels  and  determining  to  the  uterine 
organs.  In  cases  of  sudden  suppression  especially  they  frequently  have 
an  admirable  effect. 

(c?.)  Dry  Frictions. — Frictions  on  the  thighs  have  been  recommended 
by  some  as  advantageous  in  restoring  the  menstrual  discharges. 

Electricity. — Electricity  has  been  strongly  recommended  by  Nauche 
and  Siebold  of  Germany,  and  by  Dr.  G.  Bird  in  England.  It  was  used 
at  Guy's  Hospital  with  great,  and,  in  some  cases,  almost  instant  success. 
It  is  proper  only  in  those  cases  where  the  other  functions  being  well 
performed,  anaemia  not  present,  the  absence  of  the  menstrual  secretion 
is  the  only  symptom  of  disease.  In  such  cases  it  will  often  answer  an 
admirable  purpose. 

A  variety  of  other  substances  have  been  used  as  emmenagogues,  as 
hellebore,  madder,  senega,  and  of  late  strychnine.  Neither  of  them 
have  held  their  reputation,  or  justified  the  confidence  with  which  they 
were  commended  to  the  profession. 


PARTURIENTS  • 


By  this  term  is  meant  those  medicines  which  possess  the  power  o 
aiding  and  increasing  the  parturient  action  of  the  uterus.  Although  a 
number  of  agents  have  been  supposed  capable  of  producing  this  effect, 
yet  there  is  only  one  whose  character  is  sufficiently  established  to  entitle 
it  to  special  notice.     This  is  the  ergot, 

SEC ALE    CORNUTUM. 

This  is  known  by  the  common  names  of  the  spurred  rye  and  ergot. 
It  is  a  dark-colored  crooked  excrecsence  growing  from  the  rye,  pointed 
at  its  extremities,  and  resembling  the  spur  of  a  cock.  Concerning  the 
nature  and  origin  of  this  very  singular  substance  various  opinions  have 
been  entertained.  By  De  Candolle,  it  is  supposed  to  be  a  parasitic 
plant  belonging  to  the  natural  order  of  the  Fungi ;  and  he  gives  to  it 
the  name  of  the  Sclerotium  clavus.  Others  suppose  it  to  be  nothing 
more  than  a  disease  of  the  grain  itself,  produced,  as  has  been  conjectured 
by  some,  by  the  puncture  of  an  insect.  More  recently  Mr.  Quekett, 
who  has  made  the  ergot  the  subject  of  an  elaborate  investigation,  asserts 
that  it  "  is  produced  by  a  particular  species  of  fungus,  which  developes 
itself  upon  or  in  the  grain,  whilst  the  latter  is  very  young,  causing  its 
remarkable  alteration  from  a  healthy  state,  in  form,  color,  chemical 
composition  and  properties."  And  the  ergot,  he  considers  to  be  "a 
mass  composed  of  the  constituents  of  the  diseased  grain,  mixed  with 
fungic  matter,  occupying  the  place  of  the  healthy  ovary,  of  which  can 
be  observed  some  relics  in  its  triangular  shape,  and  the  furrow  on  one  of 
its  sides,  both  conditions  being  those  of  the  perfect  grain  also."  To  the 
fungus  producing  the  ergot,  Mr.  Quekett  proposes  giving  the  name  of 
Ergotoetia  abortans*  called  also  Oidium  Abortefaciens. 

Mye,  although  the  most  common,  is  not  the  only  grain  on  which  the 

*  Observations  on  the  Anatomical  and  Physiological  Nature  of  the  Ergot  of 
Rye,  and  some  other  Grasses.  By  Edwin  J.  Quekett,  Esq.,  P.L.S.  Jour,  of 
Pharmacy,  vol.  x.  p.  116. 


PAETUEIENTS.  265 

ergot  grows — it   is   round,    also,    attached    frequently  to   barley   and 
wheat. 

Properties. — The  ergot  is  generally  about  ball' an  inch  or  a  little  more 
in  length  and  half  a  line  or  more  in  thickness — curved  and  pointed  at 
its  extremities — with  a  deep  longitudinal  groove  on  one  or  both  of  its 
sides.  Externally  its  color  is  deep  violet,  internally  white.  Its  texture 
is  hard  and  brittle.  It  has  a  slightly  acid  and  pungenl  (no1  very  marked) 
taste,  and  a  faint  unpleasant  odor,  which  is  perceptible,  however,  only 
when  the  article  is  in  considerable  quantities.  It  is  specifically  lighter 
than  water.     Sound  rye  is  heavier.   : 

Chemical  Composition  and  Properties. — According  to  Vauquelin, 
ergot  contains  the  following  constituents:  first,  a  yellow  fawn-colored 
matter,  soluble  in  alcohol ;  second,  a  violet-colored  matter,  insoluble  in 
alcohol,  but  soluble  in  water  ;  third,  a  sweetish  oleaginous  matter,  in 
great  abundance;  fourth,  a  free  acid,  probably  the  phosphoric;  fifth,  an 
azotized  matter  in  great  abundance,  which  easily  became  putrid  ;  sixth, 
free  ammonia,  which  escaped  at  the  temperature  of  boiling  water.  The 
virtues  of  ergot  are  yielded  both  to  alcohol  and  water. 

Effects. — Aside  from  its  peculiar  and  truly  specific  effects  on  the 
uterus,  ergot  in  the  usual  dose  in  which  it  is  given  as  a  parturient  has 
very  little  if  any  effect  on  the  system.  In  large  doses  it  affects  the 
brain  and  nervous  system,  causing  headache  and  giddiness.  It  also 
produces  severe  irritation  of  the  stomach  and.  bowels,  nausea,  sometimes 
griping,  purging,  with  cramp  in  the  legs.  It  is  upon  the  uterus,  and 
especially  the  pregnant  uterus,  that  ergot  shows  its  powers.  When 
given  to  a  woman  in  labor  it  calls  into  most  vehement  action  the  con- 
tractile powers  of  the  uterus.  The  pains  thus  excited  differ  most 
markedly  from  those  of  natural  labor.  Instead  of  the  alternate  contrac- 
tion and  relaxation  of  the  uterus  which  takes  place  in  the  latter,  the 
contraction  is  permanent,  or  continued  with  only  partial  remissions. 
The  pains  accordingly  do  not  intermit  as  in  natural  labor,  but  there  is  a 
constant  contraction,  though  not  equally  severe  at  all  times.  An 
interesting  and  valuable  peculiarity  attending  the  action  of  this  agent  is 
that  it  produces  its  effect  on  the  uterus  with  great  promptitude.  As  a 
general  rule  it  developes  its  action  within  twenty  minutes  or  half  an 
hour.* 

Another  peculiarity  attending  the  action  of  the  ergot  is  that  it  leaves 
the  uterus  in  a  state  of  permanent  tone  after  its  contents  have  been 

*  In  twenty  cases  observed  by  Prescott,  the  time  was  precisely  marked.  "  In 
two  of  them  the  increased  strength  of  the  pains  and  the  continued  action  com- 
menced in  seven  minutes  from  the  time  the  decoction  was  taken ;  in  one  case,  it 
was  eight  minutes ;  in  seven,  it  was  ten  ;  in  three,  eleven  ;  and  in  three  others  it 
was  fifteen  minutes.  In  the  four  remaining  cases,  there  was  no  apparent  opera- 
tion until  twenty  minutes  had  expired." — P.  11. 


266  MATERIA   MEDICA   AND   THERAPEUTICS. 

expelled.     Hence  it  is  that  its  action  is  never  followed  by  hemorrhage. 
[I  wish  this  were  true,  but  think  it  is  not.] 

The  effect  which  ergot  thus  produces  on  the  impregnated  uterus  is 
not  limited  to  the  full  term  of  pregnancy.  It  exerts  the  same  kind  of 
influence  during  the  whole  of  gestation,  and  hence  it  is  that  it  has  been 
too  frequently  used  for  the  criminal  purpose  of  producing  abortion. 
Whether  it  really  possesses  this  power  has  by  some  been  doubted  [but 
abundant  experience  has  settled  the  question,  and  the  remedy  is  now 
used  in  regular  practice  to  induce  premature  labor. — Ed.] 

Uses  of  the  Ergot. — From  the  effect  of  ergot,  the -general  use  to  which 
it  is  applicable  is  obvious.  It  is  to  produce  uterine  contraction,  with  a 
view  to  expel  the  contents  of  the  uterus  or  to  arrest  hemorrhage. 
Although  used  empirically  long  before,  the  attention  of  the  profession 
was  first  called  to  the  value  of  the  ergot  as  a  parturient  agent  in  1808 
by  Dr.  Stearns,  then  of  Saratoga  county  in  the  State  of  New  York. 
Possessing  such  remarkable  powers  it  at  once  attracted  great  interest 
and  was  speedily  introduced  into  general  practice.  From  the  account 
which  has  been  given  of  its  effects  it  is  evident  that  it  is  a  remedy  of 
great  power,  and  that  it  cantiot  be  used  indiscriminately  without  much 
danger.  Nevertheless  there  are  certain  cases  in  which  it  may  be  used 
with  advantage,  and  if  properly  guarded,  without  risk.  Every  now  and 
then  cases  are  occurring  in  which  it  is  desirable  for  the  safety  of  the 
mother  as  well  as  that  of  the  child,  to  quicken  the  action  of  the  uterus 
for  the  purpose  of  expediting  the  delivery,  and  it  is  in  such  cases  that  we 
are  furnished  in  the  ergot  with  a  valuable  resource.  The  rules  which 
should  govern  its  exhibition  are  few  and  simple,  and  are  directly  deduci- 
ble  from  the  manner  in  which  it  acts  upon  the  uterus.  In  the  first  place, 
it  should  never  be  used  in  the  incipient  stages  of  labor.  The  object  of 
nature  in  this  stage  is  a  specific  one,  and  it  is  to  relax  and  dilate  the 
mouth  of  the  uterus.  In  other  words,  the  object  here  is  not  to  expel 
the  child,  but  to  prepare  the  parts  through  which  the  child  has  subse- 
quently to  pass.  Now  this  is  best  accomplished  gradually  and  by  the 
repeated  recurrence  of  pains  at  intervals,  just  as  take  place  in  unassisted 
labor.  To  stimulate  the  uterus  at  this  period  by  the  use  of  ergot  would 
be  creating  a  disproportion  between  the  means  and  the  end.  The 
uterus  would  make  unavailing  efforts,  which  might  terminate  in  rupture 
of  that  organ  ;  or  if  this  did  not  happen,  unnecessary  pain  and  suffering 
■would  be  given  to  the  patient,  while  from  the  long  continued  pressure 
to  which  the  child  would  be  subjected,  that  might  be  destroyed. 

In  the  second  place,  it  should  never  be  given  until  the  mouth  of  the 
uterus  is  dilated,  the  membranes  ruptured,  and  the  external  parts  dis- 
posed to  yield.  In  other  words,  it  should  never  be  given  until  the  parts 
through  which  the  child  is  to  pass  are  in  a  state  to  admit  of  a  speedy 
delivery,  under   the   forcing   and   expulsive  pains  of  ergot.      On  this 


I'AKI  I   KIKVI'S.  267 

account  it  is  an  agent  which  as  a  general  rule  should  be  used  with 
caution  in  first  labors,  inasmuch  as  the  parts  to  I":  dilated  are  more 
unyielding  than  they  arc.  subsequently.      In  all  cases  in  which  the  babit 
is  plethoric  and  the  fibre  rigid,  relaxation    ought  to  be  promoted  by 

venesection,  &c,  antecedent  to  its  use.     In  the  third  place,  if  should 
never  be  given  where  the  presentation  is  preternatural,  and   where  the 
operation  of  turning  may  be  required.     During  the  powerful  and  unre- 
mitting contraction  brought  on  by  ergot,  this  operation  would  be,  if 
wholly  impossible,  attended  with  great  danger. 

Lastly,  it  should  never  be  given  except  when  nature  is  incompetent 
to  a  safe  delivery.  By  too  many,  it  is  to  be  feared,  it  is  used  merely  as 
a  time-saving  agent.  Nothing  can  be  more  reprehensible  than  this 
practice.  As  a  general  rule  nature  is  competent  to  a  safe  delivery,  and 
we  may  rest  assured  that  the  best  plan  is  to  leave  her  alone  to  accom- 
plish the  work.    Artificial  and  violent  interference  cannot  but  be  improper. 

From  the  foregoing,  therefore,  it  may  be  inferred  under  what  circum- 
stances it  may  be  used  with  advantage.  In  cases  of  natural  labor,  where 
the  membranes  are  ruptured,  the  os  uteri  dilated,  and  the  head  of  the 
child  descended  into  the  pelvis,  it  may  be  used,  provided  the  natural 
efforts  of  the  uterus  are  unable  to  accomplish  the  delivery.  In  such 
cases  it  ought  to  be  used  in  preference  to  the  forceps. 

[Besides  its  use  as  a  parturient,  ergot  has  been  used  as  a  uterine 
stimulant  in  a  variety  of  cases,  and  often  with  great  success.  To  some 
of  these  uses  I  will  allude. 

1.  It  has  been,  as  I  before  stated,  used  to  bring  on  premature  labor 
in  cases  of  deformed  pelvis.  The  best  plan  in  these  cases  is,  not  to  rely 
exclusively  on  the  ergot,  but  to  give  four  or  five  doses  at  intervals  of 
four  to  six  hours,  and  then  rupture  the  membranes. 

The  operatiou  of  inducing  premature  labor  for  any  cause  involves 
very  great  responsibility,  and  should  never  be  undertaken  without  very 
deliberate  consideration,  and,  if  it  can  be  had,  a  consultation.  It  should 
never  be  done  earlier  than  the  seventh  month. 

2.  As  a  means  of  exciting  uterine  contraction,  and  checkino-  benior- 
rhage  after  labor,  here  ergot  is  often  of  great  value.  It  will  in  many 
cases  do  good,  and,  in  proper  doses,  never  can  do  any  harm.  It  should 
be  given  the  moment  the  child  is  expelled. 

3.  Ergot  has  been  successfully  used  to  excite  uterine  contraction  and 
to  expel  foreign  bodies  from  the  uterus ;  by  its  agency  polypi  of  the 
uterus  have  been  crowded  into  the  vagina  and  brought  within  the  reach 
of  the  ligature. 

Hydatids  have  in  the  same  way  been  expelled.  Ergot  has  been  ad- 
vised in  retained  placenta ;  it  ought  not  to  be  depended  on ;  also  in 
puerperal  convulsions,  where  it  is  much  more  likely  to  do  harm  than, 
good. — Ed.] 

IS 


268  MATERIA   MEDIC  A   AND   THERAPEUTICS. 


DANGERS    TO    BE    APPREHENDED    FROM    THE    USE    OF    ERGOT. 

1.  Prolapsus  Uteri. — Dr.  Dewees  states  that  lie  has  heard  of  several 
cases  of  this  kind  occurring  in  the  practice  of  a  physician  who  was  in  the 
habit  of  using  ergot  indiscriminately  in  almost  every  case  of  labor.  That 
it  may  produce  this  effect  occasionally,  even  in  the  hands  of  those  who 
use  it  discreetly,  is  proved  by  a  case  which  is  related  by  the  same 
writer.  A  lady  aborted  a  little  beyond  the  fifth  month  with  twins.  As 
the  involucra  did  not  come  away  for  some  days  after  the  embryos, 
twenty  grains  of  ergot  in  powder  were  given  with  the  effect  of  bring- 
ing them  away.  The  patient,  supposing  something  was  left  behind, 
shortly  after  took  another  dose,  contrary  to  the  advice  of  the  phy- 
sician. The  result  was  a  renewal  of  the  pains  and  a  protrusion  of  a 
considerable  portion  of  the  uterus  through  the  os  externum.  This  fact 
ouo-ht  to  furnish  a  caution  in  relation  to  the  use  of  this  article,  in  cases 
where  the  contents  of  the  uterus  have  been  evacuated,  and  where  of 
course  there  is  nothing  to  prevent  that  organ  from  being  prolapsed.* 

2.  Rupture  of  the  Perinceum. —  I  am  not  aware  that  this  has  actually 
occurred  from  the  use  of  ergot.  If  it  has  it  is  not  likely  to  be  reported. 
From  the  violence  of  the  pain,  however,  produced  by  the  ergot,  it  is  an 
accident  much  more  likely  to  occur  than  under  the  ordinary  pains  of 
labor.  The  fact  has  not  escaped  the  observation  of  those  who  have 
used  it.  Dr.  Ward  says,  "  the  contraction  of  the  womb  has  in  some 
cases  been  so  powerful,  that  I  believe  a  laceration  of  the  perinseum 
would  have  taken  place,  unless  I  had  prevented  it  by  counter-pressure."f 

3.  Hour-glass  Contraction  of  the  Womb  and  Retention  of  the  Pla- 
centa.— It  is  only  recently  that  attention  has  been  called  to  this  effect 
of  ergot,  by  M.  Chavasse,  surgeon,  of  Birmingham  in  England.  In  re- 
lation to  it  he  says,  "I  am  convinced  that  since  the  ergot  has  been 
called  into  use,  cases  of  this  kind  have  been  of  far  more  common  occur- 
rence than  formerly,"^  and  he  states  a  number  of  facts  corroborative  of 
the  truth  of  this  from  his  own  practice  as  well  as  that  of  some  of  his 
professional  friends.  Mr.  Jukes,  of  Birmingham,  states  that  in  his  first 
trials  with  the  ergot,  he  had  no  less  than  six  cases  of  retention  of  the 
placenta,  almost  in  succession;  three  of  which  are  well  marked  cases  of 
hour-glass  contraction.§  Mr.  Elkington  says,  that  "  the  exhibition  of  it 
was  so  often  followed  by  irregular  action  of  the  uterus,  sometimes  by 
increasing  and  inefficient  pains,  and  by  retention  of  the  placenta,  that  I 
now  seldom  use  it."|  Since  I  have  used  it  less  frequently  I  have  had 
very  few  cases  of  retention  of  the  placenta.    Mr.  P.  H.  Chavasse  con- 

*  American  Jour,  of  Med.  and  Physical  Science,  vol.  i.  p.  259. 

■J-  N.  T.  Med.  and  Phys.  Jour.  vol.  iv.  p.  202. 

\  State  Trans,  vol.  iii.  p.  352.  §  Ibid.  p.  354.  ||  Ibid.  p.  354. 


PAKTriUKNTK.  269 

firms  the  same,  and  expresses  the  belief  that  it  is  a  frequent  can 
hour-glass  contraction  of  the  womb.*     He  also  states  thai   in  all  the 

eases  which  came  under  his  observation  the  retention  of  the  placenta 
was  not  occasioned  by  any  adhesion  of  it  to  the  uterus,  but  simply  by 
the  hour-glass  contraction.! 

Dr.  lleane  says,,  that  "  in  the  administration  of  ergot  he  never  '•(in- 
siders himself  safe  after  the  birth  of  the  child,  until  by  Blight  extension 
he'has  drawn  the  placenta  into  the  vagina,  for  he  has  had  three  cases 
in  which  the  os  uteri  has  contracted  so  powerfully  round  the  funis,  as  to 
make  it  necessary  to  introduce  the  hand  into  the  uterus,  "  a  painful  and 
difficult  task,"  he  adds,  "  from  the  resistance  which  the  os  uteri  offered 
to  every  attempt  at  dilatation.''^ 

[4.  Besides  tdiese  many  and  great  dangers,  there  are  others  affecting 
the  mother,  viz.  rupture  of  the  uterus.  No  person  can  witness  the  tre- 
mendous efforts  to  which  the  uterus  is  excited,  when  ergot  produces  its 
full  effect,  without  the  most  vehement  apprehension  of  this  disastrous 
accident.  Although  this  may  happen  in  any  case,  and  is,  therefore,  an 
objection  to  using  the  drug  at  all,  yet  it  is  more  to  be  apprehended 
when  the  ergot  is  given  before  the  parts  are  well  prepared  to  give  way 
before  the  head,  and  permit  it  to  pass  without  delay.  The  violent 
shock  given  to  the  nervous  system.  From  this  the  patient  may  not  reco- 
ver for  a  long  time,  or  it  may  cause  convulsions  or  puerperal  mania. 

It  is  to  the  child  that  ergot  is  most  fatal.  Some  have  supposed  that 
it  has  a  directly  poisonous  influence,  but  this  I  think  is  not  proven  ; 
and  its  fatal  effects,  of  which,  alas  !  there  can  be  no  doubt,  are  to  be 
explained  by  referring  it  to  the  constant  and  very  violent  pressure  made 
on  the  head.  This  danger  will  be  diminished — it  can  never  be  avoided — 
by  not  giving  the  drug  till  the  parts  are  prepared  to  let  the  head  pass 
with  facility.  I  lay  it  down  as  a  rule,  to  which  there  are  exceedingly 
few  exceptions,  bhat  where  ergot  is  given  and  produces  its  full  effect,  if 
the  child  is  not  expelled  in  half  an  hour,  that  child  will  be  still-born. — 
Ed.] 

Chronic  Uterine  Discharges. — In  these  cases,  ergot  is  recommended 
by  Dr.  Marshall  Hall.  In  one  case  of  menorrhagia,  alternating  with 
leucorrhoea,  of  four  years'  duration,  ergot  was  given  successfully  in 
doses  of  five  grains,  four  times  a  day,  beginning  just  before  the  expected 
return  of  the  menses.  In  several  cases  of  leucorrhoea,  too,  it  was  used 
by  him  with  success.  The  effects  of  the  remedy,  according  to  him,  are 
generally  perceived  at  the  end  of  five  days.  It  should,  however,  be 
continued  some  time  longer.§ 

By  Dr.  Bellinger,  of  Charleston,  ergot  was  tried    in  menorrhagia  ; 

*  Med.  Gazette,  Jan.  1839,  p.  640.  f  Ibid.  p.  355.  %  Ibid.  p.  355. 

§  American  Jour.  Med.  Science,  vol.  vi.  p.  697. 


270  MATERIA  MEDIC  A  AND   THERAPEUTICS. 

and  he  states  the  hemorrhage  was  increased,  and  the  sufferings  of  the 
patient  greatly  aggravated.* 

Mode  of  Administration. — Ergot  is  given  in  substance,  infusion,  and 
tincture. 

Tincture. — Of  the  saturated  tincture,  a  drachm  may  be  given  every 
twenty  minutes  till  an  effect  is  produced. 

If  in  substance,  dose  3i,  to  be  repeated  every  twenty  minutes,  till  er- 
got pains  are  produced.  In  this  form,  ergot  very  often  offends  the  sto- 
mach, causing  nausea  and  even  vomiting. 

Infusion. — Generally  made  by  pouring  a  teacupful  of  water  on  one 
drachm  of  ergot  in  coarse  powder,  and  giving  one  fourth  every  twenty 
minutes. 

[The  tincture  is  the  preparation  I  generally  use  ;  I  think  it  more  reli- 
able than  either  of  the  others.  The  fluid  extract  can  also  be  depended 
on. — Ed.] 

*  Ibid.  vol.  vii.  p.  272. 


SEDATIVES. 


By  Sedatives  are  meant  that  class  of  agents  whose  direct  operation  ifi 

to  lessen  action  in  the  system.  By  some  high  authorities,  the  existence 
of  such  a  class  of  agents  is  not  merely  questioned,  but  positively  denied. 
I  will  not  go  into  any  lengthened  discussion  of  this  point  at  present,  as 
it  will  abundantly  appear  hereafter  that  though  their  number  is  undoubt- 
edly limited,  yet  there  arc  certain  agents  whose  operation  is  directly  and 
immediately  to  lessen  action  in  the  system,  and  that  without  any  previ- 
ous excitement  or  any  narcotic  power.  By  some  writers,  sedatives 
are  confounded  with  narcotics.  Now  it  is  true  that  narcotics,  like  seda- 
tives, repress  and  impair  action,  but  between  the  two  are  wide 
differences. 

For  although  both  in  their  ultimate  effects  repress  action,  yet  narcotics 
in  their  primary  action  are  exciting,  while  sedatives  are  directly  and 
immediately  repressing.  For  example,  opium  is  in  its  first  action  excit- 
ing, and  only  secondarily  does  it  prove  sedative — it  is  a  narcotic.  Blood- 
letting, on  the  other  hand,  is  at  once  depressing — it  is  a  sedative. 

Sedatives  act  mainly  on  the  vascular  system,  while  narcotics  affect 
most  obviously  the  nervous  system,  and  the  practical  application  of  the 
two  classes  of  agents  is  entirely  different ;  this  affords  us  a  strong,  and 
to  me  controlling,  reason  for  considering  them  apart. 

As  the  articles  belonging  to  this  class  are  few  and  important,  I  shall 
notice  them  so  fully  and  elaborately  as  to  preclude  the  necessity  of  any 
further  general  remarks. 


INDIVIDUAL    SEDATIVES. 

BLOODLETTING. 

Less  slaughter,  I  am  convinced,  has  been  effected  by  the  sword  than  by  the  lancet, 
that  minute  instrument  of  mighty  mischief — Reid  on  Nervous  Diseases. 

You  need  scarcely  be  told  that  this  is  one  of  the  most  potent  agents 
which  the  practitioner    has   to   wield   in    the  treatment    of  diseases. 


272  MATERIA   MEDICA   AND   THERAPEUTICS. 

According  as  it  is  used,  it  may  either  save  life  or  destroy  it.  It  is,  there- 
fore, essential  that  you  should  be  thoroughly  instructed  in  the  various 
circumstances  which  either  indicate  or  forbid  its  use.  It  is  the  more 
necessary  tbat  this  subject  should  be  very  carefully  investigated  in  this 
country,  as -there  is  but  too  much  reason  to  fear  that  great  mischief  has 
been  done  by  the  indiscriminate  use  of  the  lancet.  In  discussing  this 
subject,  I  shall  pursue  the  same  order  that  has  been  hitherto  observed, 
and  treat, — 

Of  the  Effects  of  Bloodletting. —  On  the  Vascular  System. — Here 
the  effects  produced  are  two-fold,  viz.  upon  the  blood  itself,  and  upon 
the  system  circulating  the  blood. 

On  the  Blood. — The  first  and  obvious  effect  of  bloodletting  is  the  sim- 
ple diminution  of  the  actual  quantity  of  blood  in  the  system.  But, 
although  the  whole  quantity  of  blood  in  the  system  is  diminished,  it  does 
not  follow  that  the  quantity  in  each  individual  organ  is  proportionally 
diminished.  Generally  speaking,  it  is  so  with  every  part  of  the  body 
except  the  brain.  From  the  peculiarity  of  structure  of  this  organ,  it  is 
evident  that  it  cannot  admit  of  the  same  loss  of  blood  as  all  the  other 
organs  of  the  body.  Indeed,  by  some  this  idea  is  carried  so  far,  as  to  main- 
tain that  under  no  loss  of  blood  from  the  system  at  large  can  any  material 
change  take  place  in  the  quantity  of  blood  circulating  in  the  vessels  of 
the  brain.  This  view  was,  I  believe,  first  promulgated  by  Dr.  Alexan- 
der Monro,  primus,  and  has  been  argued  pro  and  con  by  Burrows,  Aber- 
crombie,  and  others;  professional  opinion,  though  very  much  divided 
till  of  late,  has  now,  I  think,  settled  down  to  the  conviction,  that  though 
Dr.  Monro's  view  is  not  in  its  full  extent  correct,  yet  the  variation  in 
the  quantity  of  blood  in  the  brain  is  by  no  means  as  great  as  in  the 
other  organs.  In  many  cases  the  veins  of  the  dura  mater  do  not  parti- 
cipate in  the  general  bloodlessness  which  characterizes  death  from 
hemorrhage. 

This  then  is  the  first  effect  of  bloodletting,  viz.  to  diminish  the  quan- 
tity of  the  blood  in  the  system  generally,  without,,  however,  diminishing 
it  in  the  same  proportion  in  every  particular  organ.  [This  effect  is  but 
transient,  the  normal  quantity  is  soon  restored  by  endosmosis.  The 
more  important  change  is  in  quality,  for  immediately  after  a  bleeding 
the  vessels  take  up  watery  fluid  from  some  part  of  the  system,  and  thus 
the  proportion  of  water  in  the  blood  is  increased  and  the  fluid  is  less 
stimulating  to  the  heart  and  arteries. 

[The  following  table  from  Becquerel  and  Rodier  illustrates  very  strik- 
ingly the  effect  of  bleedings  on  the  blood.  It  gives  the  mean  results  of 
the  first  and  third  bleedings  in  ten  of  the  patients  in  Cruveilhier's  wards. 


SEDATIVES.  273 

r  First  bleeding.        Third  blei 

Density  of  defibrinated  blood,        L056-0  lonw; 

Density  of  scrum,  1028-8  1025'6 

Water,  793-0  833*1 

Solid  residue,  207-0  L76'9 

Albumen,  05-0  «it-0 

Fibrinc,  3-5  3-4 

Corpuscles,  129-2  99'2 

The  general  conclusion  from  these  tables  is  that  bleedings  increase 
the  quantity  of  water  in  the  blood  and  diminish  its  specific  gravity;  that 
the  quantity  of  albumen  and  fibrine  is  scarcely  at  all  affected,  while  the 
corpuscles  are  diminished  in  a  very  notable  degree. — Ed.] 

A  second  effect  of  bloodletting  is  to  diminish  the  activity  of  the  circu- 
lation. The  heart  contracts  with  less  power  upon  its  contents  and  pro- 
pels a  less  quantity  of  blood  into  the  arteries.  The  pulse,  accordingly, 
which  is  the  index  of  the  heart's  action,  becomes  smaller,  less  blood  and 
of  a  less  stimulating  quality  is  also  sent  into  the  capillaries,  and  their 
action  is  diminished.  On  the  surface  you  see  an  evidence  of  this  in  the 
paleness  which  ensues,  and  the  same  takes  place  throughout  the  system. 

These,  then,  are  the  two  effects  which  it  produces  on  the  vascular 
system,  viz.  lessening  the  quantity  and  impoverishing  the  quality  of 
blood,  and,  as  a  consequence,  impairing  the  actiou  of  the  heart  and 
bloodvessels. 

On  the  Brain  and  Nervous  System. — As  the  energy  of  the  brain  de- 
pends upon  the  due  degree  of  stimulus  which  it  receives  from  arterial 
blood  flowing  through  its  substance,  it  is  evident  that  whatever  deranges 
the  circulation  must  also  derange  the  condition  of  the  brain.  As  alrea- 
dy stated,  the  actual  quantity  of  blood  in  the  brain  is  in  all  probability 
always  very  much  the  same.  It  is  mainly  the  alteration  in  the  compo- 
sition of  the  blood  that  affects  the  brain ;  still  though  the  condition  of 
this  oro-an  be  not  affected  by  any  increase  or  diminution  of  this  fluid, 
yet  there  are  various  other  modifications  of  the  circulation  which  may 
affect  it.  For  example,  although  the  quantity  of  blood  in  the  brain  at 
any  one  time  may  not  vary,  yet  the  quantity  circulated  in  a  given  period 
may  vary  greatly,  according  to  the  frequency  of  the  contractions  of  the 
heart.  So  also  may  the  power  or  momentum  with  which  the  blood  is 
driven  by  the  heart  to  the  brain,  and  in  both  these  ways  may  the  ener- 
gy of  the  brain  be  impaired.  Now,  as  already  stated,  when  blood  is 
abstracted  by  venesection  the  action  of  the  heart  is  impaired,  the  circu- 
lation becomes  slower,  and  the  force  with  which  it  is  driven  to  different 
and  distant  parts  is  lessened.  The  brain  participates  in  this  general 
effect — the  blood  is  driven  less  forcibly  to  this  organ,  while  the  quan- 
tity circulating  through  it  is  also  less.     The  result  is  that  the  energy  of 


274  MATERIA    MEDIC  A    AND    THERAPEUTICS. 

the  brain  and  nervous  system  is  more  or  less  impaired ;  and  giddiness, 
sickness  at  stomach,  and  even  fainting  come  on. 

Relaxation  and  consequent  loss  of  power  in  the  muscles,  with  coldness 
and  a  contracted  state  of  the  skin,  are  effects  of  the  loss  of  blood  so 
familiar  and  so  easy  of  explanation  that  they  need  only  be  named. 

Circumstances  Modifying  these  Effects.  Age. — This  is  a  cir- 
cumstance modifying  very  greatly  the  effects  of  venesection,  and  requires 
especial  notice  as  lying  at  the  basis  of  the  use  of  this  important  remedy 
at  various  periods  of  life.  As  a  general  rule,  children  do  not  bear  the 
loss  of  blood  as  well  as  adults.  A  striking  illustration  of  the  difference 
between  the  effects  of  venesection  in  children  and  adults  is  seen  when 
syncope  happens  to  be.  induced.  Adults,  as  a  general  rule,  very  readily 
recover  from  this  state.  In  children,  on  the  contrary,  such  is  the 
deficient  reaction  that  they  recover  very  slowly,  and  this  state  is  always 
attended  with  more  or  less  danger.  Armstrong  says,  "  do  not  bleed  to 
actual  syncope  in  children,  as  they  are  apt  to  fall  into  convulsions,  of 
•which  they  may  die.  Another  reason  is  that  a  violent  reaction  takes 
place  after  syncope.  Children  do  not  recruit  from  very  large  bleedings 
like  adults,  especially  in  a  confined  atmosphere." 

From  twenty  to  fifty,  man  is  in  his  fullest  strength  and  vigor,  and  it  is 
during  this  period  that  the  loss  of  blood  can  best  be  borne  by  the  human 
system. 

In  Old  Age  the  action  of  the  heart  is  impaired,  the  circulation 
becomes  slower,  and  the  general  powers  of  the  system  sensibly  fail. 
Under  the  loss  of  blood,  as  a  matter  of  course,  reaction  does  not  so 
readily  take  place,  while,  if  the  quantity  be  at  all  large,  great  prostration 
will  follow.  Hence  at  this  period,  although  moderate  quantities  of 
blood  may  be  taken  with  benefit,  and  are  indeed  frequently  rendered 
necessary  by  the  venous  congestions  to  which  at  this  period  of  life  we 
are  especially  obnoxious,  yet  excessive  depletion  is  often  succeeded  by 
dangerous  or  even  fatal  sinking  of  the  system. 

Sex. — Other  things  being  equal,  as  a  general  rule,  females  do  not  bear 
the  loss  of  as  much  blood  as  males.  This  is  owing  obviously  to  the 
greater  delicacy  of  their  constitutions  as  well  as  their  more  simple  mode 
of  life.  In  considering  the  effects  of  venesection  on  the  female  system, 
there  are  three  conditions  of  it  which  require  to  be  noticed,  that  of  men- 
struation, 'pregnancy,  and  that  immediately  succeeding  the  cessation  of 
the  menses. 

During  menstruation  the  use  of  bloodletting  has  been  by  many 
objected  to,  but  without  just  reason.  The  ordinary  menstrual  discharge 
is  by  no  means  so  great  as  to  produce  anything  like  debility  in  the  sys- 
tem from  its  mere  quantity,  and  to  render  the  loss  of  blood  by  artificial 
means  at  all  objectionable,  if  it   should   be  necessary.      You   should, 


SED  ATI  VICS.  275 

therefore,  never  be  deterred  from  the  use  of  this  remedy  under  tl 
circumstances,  provided  the  otlier  symptoms  require  it. 
During  pregnancy,  also,  prejudices   bave  existed  against  the  a  e  oi 

venesection.  As  a  matter  of  fact,  however,  bloo<ll<;1.t,in^  is  much  better 
borne  in  this  state  than  in  the  ordinary  condition  of  the  system,  and 
when  diseases  occur  during  the  term  of  pregnancy  much  larger  quanti- 
ties can  be  abstracted  ;  and  indeed,  arc  absolutely  required  to  subdue  the 
disease.  [This  is  contrary  to  my  experience — I  deprecate  large  bleed- 
ings in  pregnant  women. — C.  11.  G.] 

By  some  it  is  supposed  that  the  loss  of  any  considerable  quantity  of 
blood  during  pregnancy  might  be  injurious  to  the  foetus.  This,  however, 
is  no  less  incorrect  than  the  former.  In  no  case  can  the  foetus  suffer 
directly  from  the  abstraction  of  blood  in  any  ordinary  quantity  in  cases 
of  acute  disease.  As  to  the  tendency  which  it  may  have  to  occasion 
abortion  and  indirectly  injure  the  foetus,  this  must  depend  upon  circum- 
stances.    [Of  its  tendency  to  produce  abortion  I  have  no  doubt.] 

After  the  cessation  of  the  menses  the  general  tendency  of  the  system  is 
to  become  plethoric.  This  is  the  natural  consequence  of  the  suspension 
of  a  long  continued  discharge  from  the  system.  Hence,  at  this  period, 
diseases  indicative  of  this  state  are  so  common,  such  as  apoplexy,  paralysis, 
haemoptysis,  hydrothorax,  angina  pectoris,  scirrhus.  Venesection  at 
this  period  not  only  can  be  well  borne,  but  it  is  very  often  absolutely 
called  for. 

Temperament,  or  Peculiarities  of  Constitution. — As  a  matter  of  course, 
vigorous  constitutions  bear  the  loss  of  blood  generally  better  than  those 
of  opposite  habits ;  the  nervous  and  irritable  particularly,  bearing  blood- 
letting very  bac%.  What  is  singular  in  the  effects  of  bloodletting, 
vigorous  and  athletic  subjects  not  unfrequently  faint  on  the  loss  of  a  very 
small  amount  of  blood,  while  more  delicate  persons  can  sustain  the  loss 
of  considerable  quantities  without  apparently  feeling  it.  Other  things 
being  equal,  fat  persons  cannot  bear  the  loss  of  blood  so  well  as  lean 
ones.  This  is  owing  to  two  circumstances,  viz.  their  having  less  blood, 
and  the  bloodvessels  themselves  having  less  tone  and  power. 

Peculiar  idiosyncrasies  modify  the  effects  of  venesection.  In  some 
persons  there  is  a  remarkable  tendency  to  inflammatory  action.  All 
their  diseases  partake  of  this  character.  In  these  cases  larger  and  more 
prompt  depletion  is  requisite,  and  cau  be  better  borne.  Some  persons, 
on  the  other  hand,  cannot  sustain  the  loss  of  blood. 

Besides  these  constitutional  peculiarities,  there  are  others  equally 
important,  which  result  from  the  habits  and  mode  of  life.  A  person 
bred  up  to  habits  of  industry  and  temperance,  and  along  with  these, 
enjoying  the  benefit  of  wholesome  food,  pure  country  air,  and  above  all, 
a  mind  free  from  care  and  depressing  passions,  will  bear  venesection 
incomparably  better  than  one  whose  constitution  is  undermined,  and 


276  MATERIA   MEDICA   AND   THERAPEUTICS. 

■whose  vital  energies  are  wasted  by  the  unavoidable  deprivations  to  which 
the  poor  are  subject,  or  by  the  voluntary  excesses,  debauchery,  and  intem- 
perance of  the  rich. 

With  regard  to  the  use  of  the  lancet  in  persons  who  have  long  been 
addicted  to  habits  of  intemperance,  I  cannot  too  strongly  urge  upon  you 
the  necessity  of  caution.  I  do  not  wish  you  to  understand  me  as  inter- 
dicting its  use  altogether  in  these  cases.  It  may  be  used  here  as  in 
every  other  case  where  the  nature  of  the  disease  requires  it.  The  quan- 
tity and  extent  of  it,  however,  should  always  be  modified  by  the  circum- 
stance just  mentioned. 

Climate  and  Season  of  the  Year. — By  some  it  has  been  supposed  that 
in  warm  weather  and  in  hot  climates,  venesection  is  a  remedy  which 
ought  not  to  be  resorted  to  for  fear  of  the  debility  which  it  might  in- 
duce. This,  however,  is  a  great  error.  In  every  season  and  under 
every  climate,  bleeding  may  be  practised  with  safety  and  advantage. 
Nevertheless,  there  can  be  no  doubt  that  under  certain  conditions  of 
season  and  climate,  this  evacuation  can  be  much  better  sustained  by 
the  constitution  than  under  others. 

As  a  general  rule,  bleeding  is  better  borne  during  the  winter  and 
spring  than  it  is  at  other  seasons.  The  reason  is  obvious.  In  the 
winter  and  spring,  from  the  tonic  effects  of  cold,  the  solids  of  the 
system  enjoy  the  greatest  vigor,  and  it  is  then  that  the  tendency  to 
inflammatory  complaints  is  the  greatest.  In  the  summer  and  autumn  all 
the  solids  are  relaxed,  and  the  tendency  is  to  disorder  of  the  digestive 
organs.     In  dry  weather,  too,  it  is  better  supported  than  in  moist. 

Of  the  modifying  effect  of  mere  temperature,  a  striking  instance  is 
related  by  Mr.  Hennen.  In  the  account  which  he  gives  of  the  hospital 
gangrene  among  the  troops  in  Spain,  he  states  that  anterior  to  the 
month  of  October,  the  disease  was  of  such  a  typhoid  character  as  to 
render  bloodletting  altogether  out  of  the  question.  At  this  period,  how- 
ever, a  change  took  place  in  the  weather.  From  being  sultry  it  became 
cold  ;  an  immediate  change  in  the  character  of  the  disease  followed,  and 
from  this  period  till  the  following  March,  bloodletting  was  almost  the 
only  remedy  used,  and  with  the  greatest  success. 

Climate  exerts  an  influence  analogous  to  that  of  season  and  tempera- 
ture. As  a  general  rule  in  very  hot  or  very  cold  climates  bloodletting- 
is  not  so  well  sustained  as  it  is  in  temperate  regions. 

In  very  cold  climates  bloodletting  does  not  appear  to  be  borne  to  the 
same  extent  that  it  does  in  temperate.  This  is  probably  owing  to  the 
sedative  operation  of  cold  on  the  system,  impairing  to  a  certain  extent 
the  powers  of  the  arteries.  Besides  the  mere  heat  or  coldness  of  a  cli- 
mate, there  appears  to  be  something  peculiar  to  some  regions  which 
renders  the  system  less  able  to  bear  the  loss  of  blood.  Mr.  Boyle 
states  that  on  the  western   coast  of  Africa  he  found  a  striking  differ- 


SEDATIVES.  277 

cncc  in  the  effects  of  tlie  "same  measures  upon  patients  of  apparently 
similar  constitutions,  and  under  apparently  similar  circumstances"  as 
compared  with  his  experience  in  the  East  ami  West  tndies  and  tlic 
Mediterranean.  Yet  lie  could  see  nothing  in  the  temperature  of  tlie 
climate,  which  about  averages  that  of  the  West,  [ndies  and  thai  of  the 
East  Indies,  to  account  for  the  circumstances. 

Peculiar  epidemical  conditions  of  the  atmosphere  too,  as  they  modify 
the  character  of  diseases,  necessarily  modify  the  effect  of  remedies. 
Hence  it  has  long  ago  been  observed  in  certain  epidemics  that  vene- 
section could  not  be  used  with  the  same  freedom  as  it  could  in  others 
apparently  similar. 

Repetition  of  Bloodletting. — Like  every  other  agent  used  in  medicine 
this  too  is  modified  by  repetition.  As  a  general  rule  a  second  blood- 
letting cannot  be  borne  so  well  as  the  first,  especially  if  the  second  take 
place  soon  after  the  first.  It  is  much  more  likely  to  produce  syncope. 
In  some  cases  of  disease,  however,  the  general  rule  does  not  hold  good, 
and  a  second  or  even  a  third  bleeding  will  be  better  borne  than  the  first. 
This  is  undoubtedly  owing  to  the  greater  development  of  the  disease 
after  the  first  venesection  rendering  the  system  less  susceptible  to  the 
loss  of  blood. 

Manner  of  drawing  blood,  position  of  the  patient,  d'c. — These  circum- 
stances modify  very  greatly  the  effect  of  venesection.  If  the  blood  be 
drawn  from  a  large  orifice  and  thus  very  suddenly  from  the  system,  a 
small  quantity  will  produce  as  much  and  even  greater  effect  than  a 
larger  quantity  drawn  gradually  from  a  small  orifice.  In  the  first  the 
result  may  be  syncope,  while  in  the  second  nothing  of  that  kind 
occurs. 

The  position  of  the  person  during  venesection  still  further  modifies  all 
this.  If  he  lie  on  his  back  while  blood  is  drawn  he  can  lose  a  much 
larger  quantity  without  feeling  any  immediate  effect  than  he  can  while 
either  standing  or  sitting  up. 

The  part  of  the  body  from  whence  blood  is  drawn. — Among  the  an- 
cients and  in  fact  up  to  the  period  when  the  circulation  of  the  blood  was 
discovered,  the  effects  of  bloodletting  were  supposed  to  differ  very  mate- 
rially according  to  the  part  from  which  the  blood  was  drawn ;  and  very 
precise  rules  were  laid  down  and  scrupulously  followed  in  relation  to  the 
particular  vessels  which  should  be  opened  in  different  diseases.  As  soon, 
however,  as  the  circulation  of  the  blood  was  thoroughly  understood, 
physicians  very  generally  came  to  the  conclusion  that  it  was  imma- 
terial from  what  part  of  the  body  the  blood  was  taken.  Yet  there  is 
reason  for  believing  that  the  effects  of  venesection  differ  somewhat 
according  to  the  part  from  which  the  blood  is  abstracted,  and  this 
fact  may  therefore  in  some  cases  be  usefully  applied.  Drawing  blood 
from  the  jugular  vein  has  long  been  considered  much  more  efficacious, 


278  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

in  affections  of  the  head,  than  taking  it  from  the  arm,  and  there  can  be 
no  doubt  that  it  does  possess  many  advantages.  M.  Malgaigne  recom- 
mends bleeding  in  the  foot  in  affections  of  the  portal  and  generative  sys- 
tems. Either  the  internal  or  external  saphena  may  be  opened.  Draw- 
ing blood  from  the  temporal  artery  also  produces  effects  different  from 
venesection.     Of  this,  however,  I  shall  speak  hereafter. 

State  of  the  System  as  to  Disease  at  the  time  of  Bleeding. — Of  all  the 
circumstances  already  enumerated,  there  is  none  which  so  greatly  mo- 
difies the  effects  of  bloodletting  as  this.  In  some  diseased  conditions  of 
the  system  the  loss  of  much  larger  quantities  of  blood  can  be  borne,  as 
well  as  a  more  frequent  repetition  of  it  than  in  a  state  of  perfect  health, 
while  in  other  conditions  much  less.  In  congestion  of  the  brain,  for 
instance,  immense  quantities  of  blood  are  often  drawn  without  producing 
syncope.  In  inflammation  of  mucous  membranes,  on  the  contrary,  the 
system  does  not  bear  the  loss  of  so  much.  In  other  diseases  again,  par- 
ticularly of  an  irritative  character,  the  system  succumbs  much  more 
readily  to  the  loss  of  blood.  Dr.  Marshal  Hall,  who  has  investigated 
•this  subject  with  great  ability,  arranges  diseases  in  reference  to  their 
power  of  sustaining  the  loss  of  blood  without  fainting  in  an  erect  pos- 
ture in  the  following  order,  viz  : — 

1.  Congestion  of  the  head,  or  tendency  to  apoplexy. 

2.  Inflammation  of  serous  membranes. 

3.  Inflammation  of  the  parenchymatous  substance  of  various  organs. 

4.  Acute  Anasarca. 

5.  Inflammation  of  mucous  membranes. 

Maniacs  as  a  general  rule  do  not  bear  well  the  loss  of  large  quantities 
of  blood.  Unless  the  case  be  recent  and  the  patient  have  great  consti- 
tutional vigor,  the  system  is  easily  prostrated  by  general  bleeding. 

Of  the  Effects  of  Excessive  Venesection. — There  is  no  remedy 
in  ordinary  use  which  produces  so  powerful  and  energetic  an  impression 
on  the  system  as  this,  and  in  many  cases  it  gives  rise  to  a  train  of 
symptoms  even  more  formidable  and  fatal  than  the  disease  for  which  it 
is  prescribed.  To  be  able  to  discriminate  between  the  effects  of  the 
disease  and  of  the  remedy,  is  therefore  a  matter  of  the  highest  practical 
interest;  and  it  is  to  be  feared  that  for  the  want  of  this  discrimination 
many  valuable  lives  are  continually  sacrificed. 

Of  Syncope. — This  is  one  of  the  most  common  effects  of  a  considera- 
ble loss  of  blood,  and  consists  of  a  temporary  suspension  of  the  action 
of  the  heart.  It  is  evidently  owing  to  the  sudden  or  great  abstraction 
of  blood  impairing  the  action  of  the  heart.  In  consequence  of  this  the 
brain,  receiving  less  of  the  stimulus  which  it  derives  from  the  circulating 
blood,  is  disturbed  in  its  function.  Respiration  suffers  next,  and  from  the 
sympathy  existing  between  the  brain  and  the  stomach,  nausea  and  vomit- 


SEDATIVES.  2Y0 

in g  are  frequent  occurrences,  if  the  syncope  be  protracted.  Now,  this 
effect  of  bloodletting,  although  it  is  exceedingly  beneficial  in  many  cast 
disease,  is  yet  not  altogether  unattended  with  danger;  it  has  proved 
fatal,  and  should  be  managed  with  caution.  The  first thingto  be  done  in 
cases  of  this  kind  is  to  place  the  patient  flat  on  the  back.  This  alone  mo  I 
commonly  gives  relief,  and  it  does  so  probably  because  the  heart  has 
still  power  enough  to  carry  the  blood  to  the  brain  in  the  horizontal 
position.  The  horizontal  posture  and  perfect  rest  are  the  essential 
precautions  to  be  resorted  to  in  cases  of  this  kind  ;  and  it  is  probably 
owing  to  the  neglect  of  these  that  many  fatal  accidents  have  occurred. 
In  addition  to  this,  dashing  cold  water  suddenly  on  the  face,  and  the 
application  of  aqua  ammonia)  to  the  nostrils,  are  the  remedies  to  be 
relied  on.  If  the  tendency  to  syncope  should  return,  internal  stimu- 
lants, such  as  brandy,  wine,  and  volatile  alkali,  may  be  given. 

In  some  cases,  however,  in  debilitated  habits,  and  where  the  loss  of 
blood  has  been  considerable,  the  system  does  not  react,  and  the  patient 
sinks  under  it.  It  is  proper  to  remark,  that  the  danger  of  syncope  is 
generally  in  proportion  to  the  quantity  of  blood  which  has  been  lost. 
It  is,  as  before  stated,  very  dangerous  to  children. 

Convulsions. — This  is  another  effect  which  follows  the  loss  of  large 
quantities  of  blood.  It  is  observed  most  frequently  in  children,  when 
they  are  bled  to  syncope.  In  adults,  however,  it  also  sometimes  occurs, 
and  then  it  is  occasioned  by  the  slow  abstraction  of  large  quantities  of 
blood  at  one  or  more  bleedings.  In  cases  of  this  kind,  the  spasms  are 
to  be  controlled  by  the  use  of  opium  in  some  of  its  forms  (of  which  the 
black  drop  is  as  good  as  any),  or  by  hyoscyamus.  Dr.  Hall  recom- 
mends also  the  application  of  a  sinapism  to  the  nape  of  the  neck. 

In  cases  where  delirium  ensues,  an  anodyne  is  the  best  remedy,  and 
where  the  patient  is  comatose,  counter-irritants  to  the  neck,  epigastrium, 
and  extremities. 

The  foregoing  are  the  more  commonly  observed  injurious  effects  of 
bloodletting.  There  is  another  consequence,  however,  not  so  apparent, 
but  much  more  important  in  its  results  ;  and  it  is  particularly  necessary 
that  it  should  be  understood,  inasmuch  as  it  is  apt  to  lead  physicians 
into  the  belief  that  still  further  abstraction  of  blood  is  requisite.  "What 
I  allude  to  is  the  reaction  after  the  loss  of  blood. 

Of  the  Reaction  which  follows  the  Loss  of  Blood. — In  ordinary  cases 
where  blood  has  been  drawn,  the  vascular  system  gradually  recovers 
from  the  loss,  and  returns  to  its  natural  state.  In  these  cases,  the 
reaction  may  be  considered  as  a  healthy  process.  When,  however, 
large  quantities  have  been  lost  at  repeated  bleedings,  or  by  a  long  con- 
tinued drain  of  blood,  then  this  reaction  becomes  irregular  and  tumul- 
tuous, and  it  assumes  a  character  very  apt  to  deceive  the  practitioner. 
The  heart  palpitates,  the  carotids  have  a  forcible  beat,  and  the  pulse 
becomes  morbidly  frequent  and  throbbing  or  jerking. 


2  SO  MATERIA    MEDIC  A    AND    THERAPEUTICS. 

The  brain  acquires  a  morbid  sensibility.  There  is  pain  of  the  head 
and  temples — noises  of  various  kinds  are  heard — sleep  is  disturbed,  and 
there  is  great  agitation  and  intolerance  of  light  and  sound.  The  respi- 
ration is  urgent  and  hurried,  accompanied  with  panting  and  sighing 
and  a  desire  for  fresh  air. 

Now  if  in  this  state  of  things  the  physician,  mistaking  these  symp- 
toms of  reaction  for  those  of  cerebral  congestion,  should  have  recourse 
again  to  venesection,  the  first  and  immediate  effect  would  be  in  all 
probability  to  relieve  all  the  symptoms.  This  relief  is  only  temporary, 
and  continues  no  longer  than  until  a  subsequent  reaction  takes  place. 
When  this  comes  on,  which  it  shortly  does,  all  the  symptoms  are 
renewed  and  greatly  aggravated.  If  the  loss  of  blood  be  still  further 
pushed,  the  reaction  is  subdued,  but  in  its  place  there  is  a  general 
sinking  of  the  system  and  death  is  the  result. 

Such  is  the  train  of  phenomena  which  succeed  each  other  in  these 
cases.  It  must  be  very  evident  that  as  this  reaction  is  a  vital  process, 
its  degree  and  violence  must  depend  upon  a  great  variety  of  circum- 
stances. In  young  persons  and  robust  constitutions  it  will  of  course  be 
most  violent.  In  children,  in  persons  advanced  in  years,  and  in  those 
of  naturally  delicate  and  feeble  habits,  on  the  contrary,  it  will  be  much 
more  moderate.  In  some  cases  indeed  it  may  fail  altogether  in  taking 
place,  and  then  the  system  sinks  gradually  under  the  prostrating  effects 
of  the  remedy.  Sometimes  it  has  terminated  in  mania,  at  others  in  a 
comatose  state.  From  all  that  has  been  said,  it  is  very  evident  that 
these  effects  of  the  continued  loss  of  blood  are  of  very  serious  import, 
and  require  the  greatest  skill  and  caution  in  their  treatment.  In  cases 
where  the  reaction  is  excessive,  it  is  to  be  subdued  not  by  a  repetition 
of  venesection,  but  by  remedies  calculated  to  calm  and  compose  the 
system.  These  are,  first,  perfect  rest  of  mind  and  body,  and  the  abstrac- 
tion of  every  cause  of  excitement.  Second,  opium  in  some  of  its  mildest 
forms,  or  what  is  better,  hyoscyamus.  Third,  mild  nourishment.  After 
a  while  these  will  restore  the  equilibrium  of  the  system  and  calm  the 
convulsive  reaction. 

If  there  be  pain  and  throbbing  in  the  head,  cold  spirituous  applications 
should  be  made.  In  some  cases  too  it  may  be  necessary  to  take  away 
blood  locally  by  leeches.  A  very  small  quantity  thus  abstracted  is 
frequently  of  the  greatest  benefit.  Two  or  three  leeches  in  these  cases 
have  been  known  to  give  relief.  When  delirium  is  present,  inrge  doses 
of  tincture  of  hyoscyamus  should  be  given.  It  is  interesting  to  observe 
the  blunted  sensibilities  in  syncope  and  in  sinking,  and  to  compare  them 
witli  the  morbidly  acute  sensibilities  of  the  state  of  reaction.  Sinapisms 
to  rouse  and  the  tincture  of  hyoscyamus  to  lull  them,  are,  in  their 
respective  places,  remedies  of  the  greatest  value. — Hall. 

Effusions  on  the  Brain  and  other  parts  of  the  System. — That  bleeding 
creates  a  tendency  to  effusions  in  different  parts  of  the  body  is  a  fact 


KKDA'J'IVKH.  281 

which  has  long  ago  been  observed.  In  the  brain  more  especially  this 
has  been  demonstrated.  I>r.  Leeds  was,  I  believe,  the  firsl  person  who 
made  experiments  with  tliis  view  upon  animals.  He  bled  dogs  to  death, 
and  uniformly  found  that  whether  the  blood  had  been  drawn  from  an 
artery  or  a  vein,  serum  was  effused  into  the  brain. 

With  regard  to  the  effect  of  profuse  bloodletting  on  the  other  internal 
organs,  our  facts  arc  more  scanty.  Generally,  however,  the  bronchiae 
are  found  closed  and  the  lnnjxs  oedernatous.  In  some  cases  effusions 
into  the  pericardium  and  cavity  of  the  pleura  have  been  observed. 

The  great  practical  conclusion  to  be  drawn  from  these  facts  is,  that 
there  is  a  point  beyond  which  bleeding  should  never  be  carried.  In  tin- 
application  of  this  principle  to  apoplexy  or  hydrocephalus,  it  is  obviously 
of  the  greatest  importance. 

States  of  the  System  favorable  to  the  use  of  Bloodletting. — 
Under  this  head  I  propose  not  to  indicate  all  those  cases  in  which 
venesection  is  absolutely  necessary,  but  simply  to  designate  those  general 
conditions  of  the  system  more  or  less  favorable  to  the  safe  use  of  this 
remedial  agent.  Of  the  favorable  states  of  the  system  the  following  may 
be  mentioned. 

1.  General  Plethora. — Other  things  being  equal,  just  in  proportion 
to  the  quantity  of  blood  in  the  system,  is  it  able  to  sustain  the  loss  of  it. 

2.  A  state  of  General  Vascular  Excitement. — The  reason  of  this  is 
obvious.  As  one  of  the  effects  of  bloodletting  is  to  reduce  the  action  of 
the  heart  and  arteries,  it  is  very  evident  that  when  this  action  is  excited 
bevond  the  natural  standard,  the  abstraction  of  blood  can  be  borne 
much  better  than  in  the  natural  condition  of  the  system.  As  a  general 
rule,  therefore,  a  state  of  arterial  excitement  increases  the  capability  of 
the  system  for  bearing  the  loss  of  blood  favorably.  To  this  there  are 
certain  exceptions,  however,  which  will  be  noticed  hereafter. 

3.  A  state  of  Local  Inflammation. — As  local  inflammation  is  always 
associated  with  more  or  less  general  excitement,  there  is  the  same  reason 
for  this  being  favorable  to  the  loss  of  blood  as  in  the  last  case.  In  addi- 
tion, however,  there  is  another  reason  drawn  from  the  local  affection. 
This  acts  as  a  kind  of  permanent  stimulus  to  the  heart  and  blood- 
vessels, and  therefore  the  loss  of  blood  in  these  cases  is  less  felt  than 
under  any  other  circumstances. 

4.  A  state  of  Local  Congestion. — An  organ,  instead  of  being  actively 
inflamed,  and  in  consequence  of  this,  having  its  substance  overloaded 
with  blood,  may  be  congested.  Now,  this  is  a  state  in  which  the  venous 
system  of  the  part  becomes  crowded  with  an  unnatural  share  of  blood, 
and  the  part  becomes,  as  it  were,  apoplectic.  In  this  state  the  general 
system,  instead  of  sympathizing  as  it  does  in  inflammation,  by  causing 
great  vascular  excitement,  does  it  in  a  different  way.     There  is  a  general 


282  MATERIA    MEDICA   AND   THERAPEUTICS. 

oppression,  the  circulation  instead  of  being  quickened  is  impeded,  and 
the  pulse  is  actually  slower  than  natural.  In  short,  the  system,  like  the 
organ  affected,  is  in  a  state  of  oppression.  Now,  this  condition  is  also 
favorable  to  the  abstraction  of  blood.  By  relieving  this  congestion  which 
oppresses  the  system,  the  circulation  becomes  liberated  and  more  free  in 
its  movements ;  the  pulse  increases  in  fulness  and  frequency,  while  the 
whole  strength  of  the  patient  is  invigorated. 

The  States  unfavorable  to  the  loss  of  Blood  are  the  fol- 
lowing : — 1.  "Where  there  has  been  already  a  considerable  loss. — In 
these  cases  the  further  abstraction  of  blood  may  be  immediately  at- 
tended by  dangerous  if  not  fatal  consequences. 

2.  "Where  in  consequence  of  some  shock  given  to  the  System,  the  func- 
tions of  the  Brain  and  Nerves  are  partially  suspended. — An  instance  of 
this  you  have  in  ordinary  concussion  of  the  brain.  Although  it  is 
a  very  common  practice  on  the  receipt  of  an  injury  to  have  instant  re- 
course to  venesection,  yet  nothing  can  be  more  irrational  or  dangerous. 
The  brain  and  nerves  have  been  so  much  depressed  by  the  shock  that 
any  further  debilitation,  and  especially  by  such  a  remedy  as  bloodlet- 
ting, will  often  prove  fatal.  When  the  system  recovers  from  this  state 
and  reaction  is  fully  established,  then  bleeding  is  proper  to  prevent 
inflammation.  Some  authors  advise  to  bleed  as  soon  as  reaction  be- 
gins, thinking  thus  to  prevent  the  possibility  of  inflammation.  This  is  a 
practice  to  be  resorted  to  with  very  great  caution  ;  reaction  is  an  effort 
of  nature  to  restore  the  system  to  its  natural  condition,  and  we  should 
never  interfere  with  it  till  well  assured  that  it  is  excessive. 

3.  Where  the  Brain  and  Nervous  System  have  been  affected  in  a 
peculiar  way  by  violent  injuries. — An  illustration  of  this  you  have  in 
ordinary  burns  or  scalds.  Here,  too,  the  vital  energies  are  overwhelmed, 
and  a  true  reaction  must  be  allowed  to  take  place.  With  this,  of 
course,  nothing  is  so  sure  to  interfere  as  bloodletting. 

4.  Wliere  the  Brain  and  Nervous  System  have  been  impaired  in  their 
tone  by  causes  of  more  permanent  operation,  rendering  the  whole  habit 
nervous  and  irritable. — This  state  may  be  induced  by  either  intellectual 
or  physical  habits.  Among  the  first  may  be  mentioned  excessive  and 
irregular  mental  effort,  and  among  the  second  may  be  specially  noticed 
the  excessive  use  of  intoxicating  liquor  [and  masturbation]. 

5.  A  state  of  real  debility. — Of  all  the  states  perhaps  this  is  the  one 
most  decidedly  unfavorable  to  the  loss  of  blood.  You  are  to  distin- 
guish here,  however,  very  accurately  between  real  and  apparent  debi- 
lity ;  while  the  first  is  in  every  respect  unfavorable  to  the  loss  of  blood, 
the  latter  frequently  requires  it.  Illustrations  of  real  debility  you  have 
in  the  latter  periods  of  disease ;  of  apparent,  in  various  congestive 
affections. 


BKDATIVKB.  L'83 

Op  THE  ORDINARY  MODES  OB1  JUDGING  OF  THE  PROPRIETY  OB  [IMPRO- 
PRIETY   OP    UAVJNU    RECOURSE    TO   VENESECTION. Pulse. — The    |nil  ■■•  i- 

the  index  by  which  wo  judge  of  the  actual  <•* >n< lit  ion  of  the  lir-ai  1  find 
bloodvessels,  and  the  importance  of  understanding  its  relation  to  morbid 
states,  therefore,  must  be  self-evident.  A  great  variety  of  pulses  have 
been  distinguished  by  practical  observers.  Many  of  these  distinctions 
are,  however,  altogether  too  minute  to  have  any  useful  and  practical 
application,  The  more  important  arc  the  following,  and  they  all  de- 
pend upon  various  modifications  of  the  action  of  the  heart,  the  quantity 
of  blood  thrown  out  of  that  organ,  and  lastly  the  condition  of  the  arteries 
themselves. 

A  Frequent  Pulse,  in  which  there  arc  a  greater  number  of  pulsations 
in  a  given  tinjp  than  natural.  This  pulse  depends  upon  the  rapidity 
with  which  the  contractions  of  the  heart  succeed  each  other.  The  re. 
verse  of  this  is  the  infrequent  pulse. 

A  Quick  Pulse. — This  is  often  confounded  with  a  frequent  pulse.  It 
is,  however,  entirely  distinct.  A  pulse  is  said  to  be  quick  when  each 
pulsation  is  performed  in  a  shorter  time  than  natural,  and  has  no  refer- 
ence to  the  number  of  pulsations  in  a  given  time.  This  pulse  de- 
pends upon  the  rapidity  with  which  the  heart  contracts  upon  its  con- 
tents. 

It  is  sometimes  also  called  the  jerking  pulse.  The  difference,  then, 
between  a  frequent  and  a  quick  pulse  is  this.  Frequency  relates  to  the 
number  of  beats  in  a  given  time.  Quickness  to  the  suddenness  of  the 
individual  beats. 

The  reverse  of  the  quick  pulse  is  the  slow  pulse,  in  which  the  indivi- 
dual pulsations  occupy  a  longer  time  than  natural.  The  infrequent  and 
slow  pulse  generally  go  together,  and  for  practical  purposes  may  be  con- 
sidered as  the  same. 

A  Strong  Pulse. — By  this  is  meant  a  pulse  in  which  the  artery  gives 
resistance  to  pressure.  It  depends  upon  the  force  with  which  the  heart 
contracts.     The  reverse  of  this  is  the  weak  pulse. 

A  Full  Pulse. — The  difference  between  this  and  the  strong  pulse  is 
that  the  former  is  characterized  by  its  size  and  volume.  The  full  pulse 
depends  upon  the  size  of  the  artery  and  the  quantity  of  blood  thrown 
out  by  the  heart. 

The  reverse  of  the  full  pulse  is  the  small  pulse. 

A  Hard  Pulse. — This  is  also  called  the  tense  or  chorded  pulse,  and  is 
that  pulse  in  which  the  artery  feels  like  a  wire  or  tense  cord.  It  seems 
to  depend  upon  a  rigid  or  spasmodic  condition  of  the  artery  itself. 
Generally  speaking,  the  hard  'pulse  is  full ;  not  unfrequentlv,  however, 
t  is  small  and  quick.  When  a  pulse  is  hard  and  small  it  is  called  a 
wiry  pulse.  Sometimes  known  also  by  the  name  of  catgut  pulse.  When 
a  pulse  is  hard,  quick,  and  small,  it  is  called  a  sharp  pulse.    The  reverse 

19 


284  MATERIA   MEDICA   AND   THERAPEUTICS. 

of  the  hard  is  the  soft  pulse,  in  which  the  artery  yields  readily  to  the 
fingers  and  on  pressure  becomes  easily  imperceptible. 

An  Oppressed  Pulse. — This  is  also  known  by  the  name  of  the  suffo- 
cated pulse.  By  it,  is  understood  that  pulse  which  is  apparently  weak 
and  small,  but  which  becomes  fuller  and  stronger  after  depletion.  It 
depends' upon  a  congested  state  of  some  portion  of  the  circulating  sys- 
tem interfering  with  the  free  movement  of  the  blood  as  well  as  the  action 
of  the  heart  and  bloodvessels. 

A  Regular  Pulse,  when  the  pulsations  in  a  given  time  are  regular 
and  uniform.     The  reverse  is  the  irregular  pulse. 

The  irregular  pulse  may  be  considered  as  of  three  different  kinds, 
viz  : 

The  intermitting. — When  one  or  more  beats  are  lost  in  a  given  time. 
This  arises  from  various  causes,  as  organic  disease  of  the  heart,  want  of 
blood  in  the  artery  or  weakness  in  the  heart's  action,  or  disorder  of  the 
■stomach  and  bowels,  agitation  of  mind,  &c.  In  many  persons  it  is 
matural  and  only  disappears  in  sickness.     (Heberden.) 

The  rebounding  pulse,  when  two  quick  strokes  are  followed  bj  a  slow 
•one.  This  is  indicative  of  aneurism  of  the  aorta,  ossification  of  the 
heart,  hydrothorax. 

Unequal  Pulse,  when  each  subsequent  pulsation  increases  in  strength. 
This,  if  soft,  is  said  to  indicate  a  sweat. 

The  foregoing  are  the  most  important  distinctions  to  be  made  in  rela- 
tion to  the  pulse.  To  judge  correctly  of  them  requires  tact  and  expe- 
rience, only  to  be  acquired  by  practical  and  accurate  observation.  As 
aids,  however,  in  examining  and  judging  of  the  true  character  of  the 
pulse,  the  following  rules  may  be  observed.  For  this  purpose  the  artery 
at  the  wrist  is  usually  selected  because  it  is  more  exposed. 

The  pulse  of  the  patient  should  not  be  judged  of  from  feeling  it  imme- 
diately after  entering  the  sick  room.  Any  emotion  will  quicken  the 
action  of  the  heart,  and  of  course  produce  a  change  in  the  pulse.  The 
mere  presence  of  a  physician,  especially  if  it  be  a  first  visit,  and  the 
necessary  answers  to  his  interrogatories,  will  very  generally  occasion 
some  additional  excitement.  In  females  and  irritable  patients  this  is 
much  more  likely  to  occur.  On  this  account  the  best  plan  is  to  feel  the 
pulse  several  times  during  your  visit.  By  a  neglect  of  this  plain  and 
simple  rule,  serious  blunders  have  not  unfrequently  been  committed, 
especially  by  those  who  are  ambitious  of  gaining  a  reputation  for  prompt 
and  dashing  practice. 

The  position  of  the  patient's  arm  should  be  attended  to.  It  should  be 
placed  in  such  an  attitude  that  the  muscres  are  relaxed  and  all  pressure 
removed. 

In  feeling  the  pulse,  compress  the  artery  firmly  with  your  first  three 
fingers.      Then  raise  the  'two  uppermost  gradually.     If  the  pulse  be 


SKi'A'J  i\  E  .  285 

really  strong,  it  will  strike  fully  against  the  remaining  finger.     If  it  be 
weak,  it  recovers  fulness  gradually. 

Feel  the  pulse  in  both  arms.  The  necessity  of  this  appears  from  the 
fact  that  the  pulse  is  not  always  the  same  in  both  arms.  A.  congenital 
difference  of  this  kind  is  recorded  by  Morgagni.  Zimmerman  rela 
the  case  of  a  lady  thirty-nine  years  of  age  who  bad  long  complained  of 
rheumatism  and  of  a  singular  coldness  which  extended  down  the  right 
leg  to  the  foot.  During  several  weeks  the  pulse  in  the  right  arm  was 
50,  and  in  her  left  from  80  to  92.  In  the  former  it  was  weak,  in  the 
latter  strong. 

The  pulse  of  children  under  two  years  should  be  felt,  if  possible,  while 
they  are  asleep.  The  necessary  restlessness  and  excitability  of  children 
at  that  age  invariably  quicken  the  pulse. 

By  some  physicians  it  is  advised  to  use  a  watch  to  count  the  num- 
ber of  beats.  This  will  do  very  well  for  a  young  beginner  in  practice. 
After  you  get  a  little  familiarized  with  the  pulse,  however,  it  is  best  not 
to  depend  upon  any  aid  of  the  kind;  it  is  apt  to  fix  your  attention  too 
much  on  the  mere  /requeue;/  of  the  pulse.  In  this  way  many  errors 
have  arisen.  The  best  plan  is  to  accustom  yourselves  to  judge  of  the 
pulse  by  its  general  character,  without  confining  yourselves  to  one  par- 
ticular  characteristic.  The  best  practical  physicians  I  have  ever  known 
never  resorted  to  counting  the  pulse  by  a  watch.  To  judge  of  the 
pulse,  great  experience  is  necessary.  With  the  exception  of  the  mere 
frequency,  which  can  be  measured  by  a  watch,  everything  else  is,  as 
you  perceive,  a  matter  of  feeling  and  sensation.  To  enable  you,  there- 
fore, to  discriminate  accurately  you  must  be  in  the  constant  habit  of 
feeling  the  various  kinds  of  pulses.  Cultivate  the  tactus  eruditus.  The 
importance  of  this,  gentlemen,  you  will  find  when  you  get  into  practice, 
and  when  you  see  learned  physicians  differing  in  consultation  and 
unable  to  determine  whether  a  pulse  is  hard  or  soft.  That  great  man 
Dr.  Wm  Hunter  is  said  to  have  been  completely  destitute  of  this  nicety 
of  discrimination. 

Natural  Frequency  of  the  Pulse. — In  making  up  a  judgment  in  rela- 
tion to  the  pulse,  it  should  be  recollected  that  there  are  several  circum- 
stances which  modify  its  frequency.  Of  these,  the  most  important  is 
age.  From  infancy  to  old  age  the  frequency  of  the  pulse  is  gradually 
diminishing.  The  general  average  is  :  Infancy,  140;  at  two  years,  100  ; 
at  puberty,  80  ;  manhood,  75  ;  old  age,  60. 

Sex. — As  a  general  rule  the  pulse  is  from  eight  to  ten  beats  in  the 
minute,  faster  in  females  than  males.  Temperament  also  makes  a 
difference — the  sanguineous  have  the  pulse  faster,  the  melancholic 
slower  than  the  average.  In  cold  climates  the  pulse  is  slower  than  in 
hot.  The  effect  of  posture  is  curious,  but  till  recently  has  attracted 
little  attention.     By  Dr.  Graves,  of  Dublin,  it  has  lately  been  iuvesti- 


286  MATERIA   MEDICA   AND    THERAPEUTICS, 

gated.  He  found  the  pulse  in  the  erect  posture  in  healthy  persons  from 
six  to  fifteen  beats  more  frequent  than  in  the  horizontal.  This  differ- 
ence increases  with  the  frequency  of  the  pulse  at  the  time  of  making 
the  experiment.  Thus,  if  the  pulse  is  only  sixty,  the  difference  is  not 
more  than  six  or  eight;  if  the  pulse  has  been  raised  by  exercise  to  90 
or  100,  the  difference  is  frequently  as  great  as  twenty  or  thirty. 

On  placing  the  body  in  an  inverted  position,  i.  e.  with  the  head  down- 
wards, the  pulse  was  neither  retarded  nor  accelerated,  but  very  much 
diminished  in  strength — a  fact  which  Dr.  G.  explains  by  "the  weight  of 
the  blood  pressing  on  the  aortic  valves,  and  thus  necessarily  opposing 
an  unusual  impediment  to  its  egress  from  the  left  ventricle."  In  the 
morning,  the  pulse  is  generally  more  calm  and  less  frequent  than  in  any 
other  part  of  the  day ;  after  meals  it  generally  increases  in  frequency. 
In  many  cases  the  pulse  is  characterized  by  some  peculiar  constitutional 
idiosyncrasy,  rendering  it  preternaturally  frequent  or  slow.  Heberden 
relates  the  case  of  a  man  aged  fourscore,  whose  pulse  during  the  last  two 
years  of  his  life  was  seldom  over  thirty,  and  sometimes  not  more  than 
twenty-six ;  yet,  he  enjoyed  good  health.  Napoleon's  pulse  is  said  to 
have  been  only  forty-four  in  a  minute.  Dr.  Copland  mentions  a  case  of 
a  man  eighty-seven  years  old  in  good  health  and  spirits,  whose  pulse  is 
only  twenty-nine  in  a  minute.  Dr.  Thomson  relates  the  case  of  a  man 
whose  pulse  in  health  was  never  more  than  forty-five ;  and  what  is  very 
curious,  whenever  he  was  feverish,  it  fell  to  forty. 

Having  thus  noticed  the  different  varieties  which  the  pulse  assumes, 
and  pointed  out  the  circumstances  which  modify  even  the  healthy  con- 
dition of  it,  it  will  be  easy  to  understand  what  I  have  to  say  in  relation 
to  the  use  of  the  lancet  as  indicated  by  it. 

Of  all  the  different  kinds  of  pulses  which  have  been  enumerated,  the 
one  which  calls  most  imperatively  for  the  use  of  the  lancet  is  that  which 
is  characterized  by  frequency  and  hardness.  When  this  kind  of  pulse  is 
present,  it  indicates  the  existence  of  inflammatory  action,  and  of  course 
shows  the  necessity  of  bloodletting.  Mere  frequency  of  the  pulse  does 
not  require  or  justify  it.  Usually  this  occurs  in  habits  naturally  irrita- 
ble or  rendered  so  by  the  operation  of  debilitating  causes,  in  both  of 
which  cases  venesection,  so  far  from  diminishing,  would  only  serve  to 
increase  it.  Nor  does  mere  hardness  of  the  pulse,  unaccompanied  by 
frequency,  always  indicate  the  necessity  of  bleeding.  In  aged  persons, 
not  unfrequently  the  pulse  assumes  a  peculiar  hardness  from  ossification, 
or  some  other  organic  changes  in  the  artery;  it  is  only  where  hardness 
and  frequency  are  combined  that  venesection  is  rendered  necessary. 

The  oppressed  is  another  pulse  requiring  the  use  of  the  lancet,  and 
here  its  propriety  is  indicated  by  the  development  or  rise  of  the  pulse, 
.as  it  is  called,  after  depletion. 

With  regard  to  the  other  conditions  of  the  pulse,  they  may  or  may 


SEDATIVES.  287 

not  indicate  the  necessity  of  bleeding,  according  to  circum  fcanei  .    A 
strong  pulse,  when  the  system  is  plethoric,  and  there  is  danger  of  local 
determination,  may  require  bloodletting,  while  under  other  circum  tai 
it  may  not.     Sometimes  a,  soft  pulse  may  demand  extensive  depletion. 

Not  unfrequently  a  pulse  preternaturally  slow  calls  for  the  rnosl  active 
depletion.  Tins  occurs  in  apoplexy  and  other  diseases,  when  ther< 
oppression  of  the  brain.  Jn  cases  of  this  kind,  the  pulse  is  sometimi 
slow  as  fifty  and  forty  in  a  minute.  Here,  however,  it  is  necessary  to 
make  a  nice  distinction,  as  all  cases  of  this  kind  do  not  require  bloodlet- 
ting. They  only  do  so  when  this  condition  of  the  pulse  exists  with 
active  determination  to  the  brain. 

Sometimes  a  very  small  pulse  requires  bloodletting.  Illustration-  of 
this  occur  in  such  diseases  as  enteritis,  dysentery,  &c,  where,  from  the 
great  flow  of  blood  to  the  internal  organs  which  are  diseased,  the  ves 
in  the  extremities  are  deprived  of  their  ordinary  proportion.  How  to 
distinguish  when  a  small  pulse  requires  depletion  is  not  very  easy.  The 
rule  laid  down  by  Lawrence  is,  that  when  the  heart  beats  proportion- 
ally stronger  than  the  arteries,  bleeding  may  be  resorted  to,  and  vice 
versa.  The  only  safe  rule,  however,  is  the  actual  effect  produced  on  the 
pulse  during  the  flow  of  blood.  If  it  fills  and  rises,  it  is  a  proof  of  its 
propriety,  and  vice  versa. 

From  all  this  it  is  evident,  that  however  much  valuable  information 
may  be  gained  from  the  state  of  the  pulse,  it  is  by  no  means  an  infalli- 
ble guide  to  the  use  of  the  lancet.  In  all  cases  it  must  be  taken  in  con- 
nexion with  the  other  symptoms. 

Pain  is  another  circumstance  by  which  a  judgment  is  formed  con- 
cerning the  propriety  of  venesection.  Mere  pain,  however  severe, 
when  unaccompanied  by  any  corresponding  derangement  in  the  circu- 
lation, does  not  require  depletion.  Striking  illustrations  of  this  you  have 
in  ordinary  toothache  and  in  tic  douloureux.  Indeed,  mere  pain  does 
not  usually  exercise  much  influence  in  accelerating  the  movements  of 
the  circulation.  A  high  authority,  the  late  Dr.  Heberden,  says,  "  it  is 
often  supposed  that  great  pain  will  quicken  the  pulse  ;  I  am  more  sure  the 
mere  pain  will  not  always  do  it,  than  I  am  that  it  ever  will."  He  adds, 
"the  violent  pain  occasioned  by  a  stone  passing  from  the  kidneys  to  the 
bladder  is  often  unattended  with  any  quickness  of  pulse ;  aud  the  excessive 
and  almost  intolerable  torture  produced  by  a  gall  stone  passing  through 
the  gall  ducts,  has  in  no  instance  quickened  the  pulse  beyond  its  natural 
pace,  as  far  as  I  have  observed,  though  it  be  a  disorder  which  occurs  so 
frequently;  and  this  natural  state  of  the  pulse,  joined  with  the  vehement 
pain  about  the  pit  of  the  stomach,  affords  the  most  certain  diagnosis  of 
the  illness.  I  have  seen  a  man  of  patience  and  courage  rolling  upon  the 
floor  and  crying  out  through  the  violence  of  this  pain,  which  I  was 
hardly  able  to  lull  into  a  tolerable  state  with  nine  grains  of  opium,  given 


288  MATERIA   MEDICA   AND   THERAPEUTICS. 

in  twenty-four  hours,  to  which  he  had  never  been  accustomed,  and  yet 
his  pulse  was  all  this  time  as  perfectly  quiet  and  natural  as  it  could  have 
been  in  the  sweetest  sleep  of  perfect  health."  Mere  pain,  then,  does 
not  render  venesection  necessary.  When,  however,  it  is  associated  with 
a  hard  and  frequent  pulse,  or  with  a  strong  slow  pulse,  as  in  congestion 
of  the  brain,  or  with  general  inflammatory  symptoms,  then  it  forms  a 
most  valuable  criterion  by  which  to  judge  not  merely  of  the  necessity  of 
depletion,  but  of  the  extent  to  which  it  may  be  carried. 

A  tongue  with  a  white  fur,  if  other  symptoms  correspond,  is  an  index 
of  the  propriety  of  bloodletting,  as  it  generally  indicates  the  existence 
of  inflammation.  The  quantity,  of  course,  to  be  regulated  by  other  cir- 
cumstances. 

Mr.  Lawrence,  in  a  lecture  on  disorders  of  the  digestive  organs,  speaks 
of  a  tongue  as  white,  "  not  in  consequence  of  its  being  covered  by  any 
deposit  or  secretion,  but  as  if  from  the  substance  of  the  tongue  itself 
being  rendered  white.  This  is  observed  in  cases  either  of  plethora, 
when  passing  almost  into  a  condition  of  disease,  or  in  cases  of  active 
inflammatory  disturbance,  and  is  an  indication  of  these  states  rather 
than  of  particular  disturbance  of  the  stomach.  It  is  a  tolerably  unerring 
criterion  of  the  existence  of  inflammation,,  and  it  may  be  considered  as  a 
sign  that  we  ought  to  bleed  those  individuals  in  whom  it  is  noticed." — 
London  Medical  Gazette,  vol.  v.  p.  197. 

If  along  with  the  other  symptoms  already  noticed  the  skin  be  hot  and 
dry,  it  is  an  additional  reason  justifying  the  use  of  the  lancet. 

The  Nature  of  the  Part  Affected  is  a  very  important  circumstance 
in  enabling  us  to  judge  of  the  necessity  of  bloodletting.  Analogous 
symptoms  resulting  from  diseases  of  different  organs  require  different 
modes  of  treatment.  Inflammation  occurring  in  different  organs 
demands  a  totally  different  use  of  the  same  remedy.  Diseases  of  the 
chest,  for  instance,  require  more  prompt  and  repeated  depletion  than 
those  of  any  other  organ,  and  the  relief  which  it  affords  is  more  apparent. 

Inflammation  of  mucous  membrane  docs  not  generally  require  the 
same  active  depletion  as  that  of  the  serous  membranes. 

The  Stage  of  the  Disease  is  a  very  important  circumstance  in  deter- 
mining upon  the  propriety  of  bloodletting.  Even  in  diseases  requiring 
this  remedy,  if  it  be  delayed  beyond  a  certain  period,  it  is  wholly  inad- 
missible. As  a  general  rule,  in  all  cases  where  it  is  called  for  the  earlier 
it  is  used  the  better.  And  this  because  it  makes  a  more  immediate  and 
decided  impression,  and  at  a  time  when  the  powers  of  the  constitution 
are  best  able  to  sustain  the  loss  of  blood;  and  also  prepares  the  system 
in  the  best  possible  way  for  the  effective  operation  of  whatever  medicines 
the  case  may  require.  After  bloodletting,  for  instance,  emetics,  cathar- 
tics, and  in  fact  all  other  remedies  act  more  efficiently  than  they  would 
previously. 


si: DATIVES.  2    9 

Of  the  Appearance  of  the  Blood. — By  many  mud  Btrei  •  ba  been  laid 
upon  this  as  indicative;  of  the  propriety  and  necessity  of  bloodletting. 
That  the  blood  assumes  different  appearances  in  differenl  condition  of 
the  system,  is  certain,  and  from  these,  important  conclusions  may  un- 
questionably be  drawn  in  many  Cases,  especially  if  taken  in  connexion 
with  other  circumstances.  As  a  genera!  rule,  when  the  proportion  of 
crassamentum  in  the  blood  is  large,  it  may  be  taken  as  the  evidence  of 
constitutional  vigor,  and  of  the  capabilities  of  the  system  for  sustaining 
the  loss  of  blood.  As  a  general  rule,  too,  when  the  crassamentum  is 
very  firmly  coagulated,  the  loss  of  blood  can  be  better  sustained  than 
when  it  is  loosely  held  together.  The  more  slowly  the  blood  coagulates 
the  better  will  the  abstraction  of  blood  be  borne. 

Of  all  the  characteristics  of  the  blood,  that  upon  which  the  greatest 
reliance  is  usually  placed  is  the  huffy  coat.  As  this  by  many  is  looked 
upon  as  a  certain  sign  for  the  necessity  of  bloodletting,  it  is  proper  to 
dilate  a  little  upon  it.  The  formation  of  the  buffy  coat  is  owing  to  the 
manner  in  which  the  blood  coagulates.  In  the  ordinary  healthy  con- 
dition of  the  fluid  it  coagulates  rapidly,  and  when  that  is  the  case  the 
red  globules  remain  diffused  throughout  the  whole  mass.  In  certain 
morbid  states,  however,  the  blood  coagulates  more  slowly  and  the  red 
globules  gradually  subside  towards  the  bottom.  On  examining  the  blood, 
therefore,  it  will  be  found  that  while  the  middle  and  lower  parts  of  the 
crassamentum  contain  the  red  globules,  the  upper  part  is  destitute  of 
them.  This  part  thus  deprived  of  the  red  globules  makes  what  is 
denominated  the  buffy  coat.  That  this  buffy  coat  is  present  in  cases  of 
inflammation  is  unquestionable,  but  as  the  formation  of  this  coat  depends 
(as  already  explained)  upon  the  slow  coagulation  of  the  blood,  it  is  very 
evident  that  whatever  modifies  the  coagulation  must  also  modify  this 
peculiar  appearance.  For  example,  if  blood  be  drawn  from  a  small  ori- 
fice and  very  slowly,  it  will  coagulate  so  rapidly  as  to  prevent  the  form- 
ation of  the  buffy  coat,  even  though  under  an  opposite  mode  of  abstrac- 
tion it  would  show  it. 

On  the  other  hand,  numerous  observations  have  established  the  fact 
that  the  buffy  coat  is  frequently  present  when  no  inflammatory  action 
exists.  If  blood  be  taken  from  a  person  in  full  health,  after  violent 
exercise,  the  buff  will  show  itself  in  the  blood.  In  pregnancy  the  blood 
often  puts  on  the  same  appearance.  The  same  thing  is  observed  in 
blood  drawn  from  persons  under  a  mercurial  course.  In  the  last  stages 
of  disease  it  sometimes  shows  itself.  Sir  Astley  Cooper  relates  the  case 
of  a  patient  in  Guy's  Hospital  "  in  the  last  stage  of  scurvy,  whose  blood- 
vessels were  so  weak  that  a  slight  pressure  on  the  skin  produced  ecchy- 
mosis,  whose  gums  frequently  bled,  and  whose  pulse  was  exceedingly 
quick  and  feeble."  By  way  of  experiment  a  small  quantity  of  blood 
was  taken  from  his  arm ;  "  after  standing  a  few  hours  it  became  not 


290  MATERIA   MEDICA   AND   THERAPEUTICS. 

only  buffy  but  considerably  cupped."  In  pulmonary  consumption  it 
not  u infrequently  continues  to  be  seen  to  the  last  moment  of  life.  From 
the  foregoing  facts,  it  is  evident  that  the  buffy  coat  is  by  no  means  an 
infallible  criterion  by  which  to  judge  of  the  necessity  of  depletion  ;  it 
should  be  considered  in  connexion  with  the  other  circumstances  in  the 
case,  and  if  this  precaution  is  observed  it  may  assist  materially  in  form- 
ing a  correct  judgment. 

Of  the  extent  to  which  Bleeding  should  be  carried. — On  this  subject  it 
is  impossible  to  lay  down  any  precise  rule.  In  determining  the  quan- 
tity to  be  taken  in  any  particular  case,  everything  must  depend  upon 
the  constitution  of  the  patient,  his  general  habits,  the  character  and 
seat  of  the  disease,  and  above  all  the  effect  produced  upon  the  pulse. 
In  acute  disease,  where  the  patient  is  seen  in  the  early  stages  and  when 
it  is  desirable  to  make  a  decided  impression,  the  best  plan  is  to  carry 
the  bleeding  so  far  as  to  affect  the  pulse,  and  in  some  cases  to  produce 
actual  syncope.  With  regard  to  the  repetition  of  the  bleeding,  this 
must  be  decided  by  existing  symptoms.  If  those  originally  indicating 
venesection  be  not  mitigated,  or  if,  after  being  partially  subdued,  they 
return  with  their  primitive  violence,  the  remedy  may  be  repeated,  as  a 
general  rule,  after  an  interval  of  about  six  hours.  In  cases  of  great 
severity,  however,  or  when  the  disease  is  known  to  run  its  course  in  a 
very  short  period,  as  in  laryngitis,  it  may  be  repeated  after  a  shorter 
interval.  Generally,  however,  the  necessity  of  a  second  bleeding  will 
be  greatly  lessened  by  conducting  the  first  in  such  a  way  as  to  make  a 
decided  impression  on  the  system. 

In  having  recourse  to  venesection  in  children,  the  greatest  discretion 
should  be  exercised,  both  in  regard  to  the  quantity  which  is  drawn  as 
well  as  to  its  repetition.  It  has  already  been  stated,  when  speaking  of 
age  as  modifying  the  effects  of  this  remedy,  that  young  children  bear 
bleeding  very  ill.  If  carried  at  all  far,  they  are  apt  to  sink  under  it. 
From  a  child  six  months  old  the  average  quantity  may  be  put  at  one 
ounce,  and  if  necessary  to  repeat  it,  another  in  twelve  hours  afterwards. 

Should  young  children  be  bled  to  syncope  under  any  circumstances  ? 
This  is  recommended  in  some  cases  where  the  child  is  plethoric  and 
the  inflammation  runs  high.  In  some  very  rare  cases  it  may  be  judi- 
cious, but  beyond  all  doubt  it  should  be  resorted  to,  if  at  all,  with 
extreme  caution.  [I  concur  in  the  opinion  of  a  late  writer  who  says, 
"  bleeding  children  to  syncope  is  the  worst  practice  that  can  be  ima- 
gined."] 

In  taking  blood  from  persons  advanced  in  years,  due  allowance  should 
be  made  for  that  circumstance,  and  more  moderate  quantities  taken 
than  from  younger  persons. 

Different  modes  of  abstracting  blood. — These  are  general  and  local. 

Everything  that  has  already  been  said  applies  to  general  bloodletting 


'  SEDATIVKS.  201 

and  to  the  ordinary  mode  in  which  it  is  drawn  from  the  arm.    The  other 

modes  are  taking  it  from    the  external  jugular  vein  and  from,  an  artery. 
These  only  require  a  brief  notice 

1.  Jugular  Vein. — Next  to  drawing  blood  from  the  arm,  this  is  the 
mode  of  general  bloodletting  which  lias  been  the  most  popular.  I 
think  that  in  some  cases  bleeding  from  the  jugular  vein  has  a  great 
advantage.  In  the  first  place  it  draws  blood  more  directly  and  imme- 
diately from  the  head,  and  empties  the  veins  and  sinuses  of  thai  organ 
in  a  way  which  cannot  be  accomplished  by  bleeding  from  the  arm. 
Hence  in  certain  diseases  of  the  brain  its  beneficial  effects  are  much 
more  prompt  and  unequivocal. 

In  the  second  place,  as  the  vessel  is  larger  than  those  of  the  arm, 
blood  can  be  drawn  with  much  more  rapidity  and  certainty.  The  im- 
portance of  this  must  be  self-evident,  after  what  has  been  already  said 
in  relation  to  difference  of  effect  between  the  rapid  and  slow  abstraction 
of  blood.  Notwithstanding  this  it  should  not  be  used  where  bleeding 
from  the  arm  will  answer,  inasmuch  as  it  is  attended  with  more  incon- 
venience and  not  unfrequently  with  some  danger. 

2.  Arteriotomy. — This  is  another  mode  of  general  bloodletting  much 
more  common  formerly  than  at  present.  Among  the  ancients  it  was 
in  great  favor.  At  present  the  only  artery  opened  is  the  temporal. 
What  the  precise  difference  is  between  drawing  blood  from  the  vein 
and  an  artery  is  a  question  of  importance,  and  has  given  rise  to  some 
interesting  investigations  and  experiments.  The  most  valuable  are 
those  of  Dr.  Leeds,  and  from  them  the  following  conclusions  were 
drawn. 

(1.)  Taking  blood  from  an  artery  diminishes  more  especially  the 
quantity  of  venous  blood  ;  therefore,  arteriotomy  is  to  be  performed 
when  the  veins  are  tumid. 

(2.)  The  loss  of  arterial  blood  does  not  speedily  disturb  the  respira- 
tion, nor  the  heart's  motion,  nor  does  it  rapidly  break  the  strength  ; 
therefore,  when  we  particularly  wish  to  preserve  entire  the  more 
important  functions  let  arteriotomy  be  had  recourse  to. 

(3.)  From  arterial  bleeding,  convulsions  appear  not  apt  to  occur ; 
therefore,  against  such  affections  arteriotomy  would  most  avail. 

(4.)  Blood  let  from  veins  does  not  particularly  diminish  the  quantity 
of  venous  blood,  but  greatly  disturbs  respiration  and  the  heart's  motion, 
debilitates  to  a  surprising  degree,  makes  the  veins  very  turgid,  and 
induces  convulsions ;  therefore,  when  the  circulation  is  universally 
strong,  as  in  every  active  inflammation,  venesection  will  be  most 
serviceable. 

Local  Bloodletting. — 1.  Leeching. — This  is  one  of  the  most  com- 
mon of  the  modes  of  local  depletion  at  present  in  use.     The  animal  by 


292  MATEEIA   MEDICA   AND  THEEAPEUTICS. 

whose  means  it  is  effected  is  the  Hirudo  Medicinalis,  very  common  in 
Europe  and  in  this  country,  found  inhabiting  lakes  and  stagnant  pools* 
The  leech  is  of  various  sizes,  the  European  leech  is  generally  from  one 
to  three  inches  in  length,  while  the  Indian  leech  is  six  or  seven. 

•The  body  of  this  animal  is  composed  of  cartilaginous  rings  capable 
of  great  distension.  Its  month  is  triangular,  and  the  wound  which  it 
inflicts  is  of  the  same  shape.  These  animals  are  very  much  affected  by 
the  weather.  During  the  winter  they  remain  in  an  almost  torpid  state, 
hid  deep  in  ground  at  the  bottom  of  the  pools.  They  are  caught  in 
the  spring  and  autumn,  and  as  they  generally  rise  to  the  surface  before 
a  thunderstorm,  this  is  a  very  good  time  for  collecting  them. 

As  there  is  frequently  considerable  difficulty  in  making  leeches  bite 
well,  various  modes  have  been  proposed  to  effect  this  object.  The  best 
are  the  following.  The  part  to  which  they  are  to  be  applied  is  first  to 
be  well  washed,  and  if  covered  with  hair  to  be  shaved.  For  the  pur- 
pose of  making  the  leech  fasten,  it  is  recommended  to  puncture  with  a 
lancet  so  as  to  draw  a  little  blood.  The  leeches  are  then  to  be  confined 
over  the  spot  by  means  of  a  common  wine  glass.  It  generally  takes 
from  half  an  hour  to  an  hour  for  leeches  to  fill  themselves.  Commonly 
after  being  filled  they  fall  off  spontaneously.  When  they  do  not  let  go, 
they  may  be  separated  by  means  of  a  pin  or  thread  drawn  between 
the  leech  and  the  skin. 

The  quantity  of  blood  which  a  leech  draws  must  of  course  vary  with 
the  size  of  the  animal,  and  the  facility  with  which  the  blood  flows.  As 
a  general  rule,  not  more  than  about  two  drachms  is  procured.  The 
quantity  actually  taken  away  by  the  leeches  is  small  when  compared 
with  what  may  be  procured  from  the  bites  after  they  fall  of.  To  do  this 
the  part  is  to  be  sponged  with  warm  water,  or  what  is  better,  a  common 
warm  bread  and  milk  poultice  is  to  be  applied.  This  causes  a  free  dis- 
charge of  blood  without  any  inconvenience  to  the  patient. 

The  facility  with  which  they  bite,  as  well  as  the  quantity  of  blood, 
depend  greatly  upon  the  character  of  the  surface  to  which  they  are 
applied.  In  delicate  skins,  where  the  capillary  circulation  is  active, 
more  blood  is  always  drawn  than  in  dense  and  rigid  skins.  Hence,  in 
children  and  delicate  persons,  the  hemorrhage  from  leeches  is  some- 
times excessive.  For  the  same  reason,  certain  parts  of  the  body  are 
more  favorable  to  the  application  of  leeches  than  others. 

Effects  on  the  System. — These  are  local  and  general.  Their  first  and 
immediate  effect  is  to  unload  the  system  of  capillary  vessels  upon  which 
they  act.  In  addition  to  this,  by  the  wounds  which  they  inflict,  they 
cause  a  certain  degree  of  irritation  in  the  surface.  These  are  the  local 
effects.  The  general  are  analogous  to  those  of  venesection,  and  vary 
according  to  the  quantity  of  blood  which  the  leeches  abstract. 

Accidents  happening  from  the  use  of  Leeches. — In   speaking  of  the 


SEDATIVES.  -':,-; 

effects  of  leeches,  tliesc  require  notice,  especially  as  some  of  them  are 
of  very  serious  import. 

1.  The  first  is  excessive  bleeding.  This  happepe  nol  [infrequently,  and 
occurs  most  commonly  in  children  and  in  those  whose  capillary  vessels 
arc  very  active.  In  a  hot  climate  it  is  sometimes  difficult  to  stop  the 
bleeding  from  leeches  as  well  as  from  phlebotomy.* 

Dangerous  and  even  fatal  hemorrhages  have  thus  been  known  to 
occur  in  young  subjects.  In  all  cases,  therefore,  a  child  to  whom 
leeches  have  been  applied  should  never  be  left  until  after  it  has  been 
ascertained  that  there  is  no  danger  from  this  source.  Sometimes  it  is 
difficult  to  arrest  the  bleeding  even  by  artificial  means,  and  various 
modes  of  doing  this  have  been  resorted  to.  Generally  speaking  the 
application  of  adhesive  plaster  with  a  compress  and  bandage  will 
answer  every  purpose.  Another  good  way  is  a  piece  of  sponge  rolled 
in  flour  or  gum  arabic.  The  simple  application  of  cold  water  some- 
times succeeds.  If,  however,  the  bleeding  still  continues,  the  best  plan 
is  to  put  the  point  of  a  stick  of  lunar  caustic  into  the  orifice  and  hold  it 
there  for  a  short  time.  After  this  a  small  piece  of  punk  is  to  be  applied. 
This  generally  adheres  and  puts  a  stop  to  the  bleeding,  In  other  cases 
the  actual  cautery  requires  to  be  applied.  In  Lord  Byron's  case  the 
bleeding  could  not  be  stopped  till  the  actual  cautery  was  used.  If  after 
this  it  should  still  continue,  nothing  is  to  be  done  but  to  make  constant 
pressure  on  the  part  until  it  is  arrested.  Where  pressure  cannot  con- 
veniently be  made,  Mr.  Marshall  of  Dublin  recommends  pinching  up 
the  portion  of  skin  around  the  leech-bite,  and  continuing  moderate  but 
not  painful  pressure  for  ten  or  fifteen  minutes,  when  the  hemorrhage 
will  be  found  to  have  ceased. 

2.  Opening  into  an  Artery. — This  sometimes  happens  from  the  appli- 
cation of  leeches,  and  requires  to  be  guarded  against.  A  case  of  this  kind 
occurred  in  which  the  temporal  artery  was  thus  opened,  and  Sir  Astley 
Cooper  was  obliged  to  divide  the  artery  completely  before  the  hemor- 
rhage could  be  arrested. 

3.  Inflamed  Leech-bites. — This  is  sometimes  an  unpleasant  conse- 
quence of  the  application  of  these  animals.  The  best  way  to  treat  this 
is  upon  the  principle  of  Mr.  Iligginbottom,  by  the  application  of  nitrate 
of  silver.  Sometimes  an  erysipelatous  inflammation  takes  place,  which 
has  usually  been  ascribed  to  an  irritable  state  of  the  skin.  It  has  been 
ascertained,  however,  now  to  be  owing  to  the  forcible  pulling  off  of  the 
leech,  causing  the  teeth  to  be  separated  and  left  in  the  wound.  This 
shows  of  course  the  propriety  of  leaving  the  leech  to  drop  off. 

Number  of  Leeches  to  be  apirtied. — In  adults  from  ten  to  thirty  may 
safely  be  applied.     To  an  infant  one  or  two  are  sufficient. 

*  *  Aiuslie,  vol.  i.  p.  192. 


294  MATERIA   MEDICA   AND   THERAPEUTICS. 

2.  Cupping. — This  operation  is  performed  by  first  scarifying  the  part 
and  then  applying  exhausted  cups,  for  the  purpose  of  taking  off  the 
pressure  of  the  atmosphere.  In  this  way  a  determination  of  blood  is 
caused  to  the  part,  and  a  free  evacuation  from  the  scarified  vessels.  Of 
the  particular  manner  of  performing  the  operation  it  is  unnecessary  to 
speak. 

Cupping  is  analogous  to  leeching,  inasmuch  as  it  bleeds  locally  ;  it  dif- 
fers, however,  in  some  important  respects.  It  creates  more  external  irri- 
tation, and  it  has,  therefore,  the  advantage  of  being  more  of  a  counter- 
irritant — it  draws  blood  more  promptly,  and  lastly,  you  have  the  bleed- 
ing more  under  your  control ;  none  of  the  accidents  which  occur  after 
leeching  take  place  here. 

Relative  Value  of  General  and  Local  Bloodletting. — General 
bloodletting  takes  blood  promptly  and  suddenly  from  the  system ;  local 
bloodletting  takes  it  slowly  and  gradually. 

General  bloodletting,  therefore,  makes  a  prompt  impression  upon  the 
action  of  the  heart  and  blood-vessels,  from  the  mere  suddenness  with 
which  the  stimulus  of  the  blood  is  withdrawn  from  these  organs.  This 
effect  may,  therefore,  be  produced  almost  independently  of  the  quantity 
of  the  blood  drawn.  Local  bloodletting,  if  it  affects  the  heart  and  cir- 
culation at  all,  must  do  it  by  the  actual  quantity  of  blood  lost.  General 
bloodletting  affects  the  whole  circulation  and  acts  upon  the  system — 
through  the  intervention  of  the  general  circulation.  Local  bloodletting 
on  the  contrary  acts  on  the  capillary  system  of  vessels,  and  through  that 
on  the  system  at  large;  or  in  other  words,  general  bloodletting  acts  pri- 
marily on  the  heart  and  arteries,  and  secondarily  on  the  capillary  vessels  ; 
while  local  bloodletting  acts  primarily  on  the  capillary  vessels,  and 
secondarily  on  the  heart  and  arteries.  In  general  bloodletting  all  the 
effects  are  to  be  attributed  to  the  mere  loss  of  blood.  In  local  bloodlet- 
ting there  is  an  additional  effect  obtained  in  the  local  irritation  which  is 
caused,  and  which  in  some  cases  is  of  great  practical  advantage. 

The  practical  distinction  then  between  the  two  modes  of  depletion  is 
this.  Whenever  you  wish  to  produce  a  prompt  and  decided  effect  on 
the  heart  and  blood-vessels,  and  whenever  the  general  circulation  re- 
quires particularly  to  be  operated  on,  general  bloodletting  is  to  be  pre- 
ferred. When,  on  the  contrary,  you  wish  simply  to  unload  a  portion  of 
the  capillary  system,  without  any  special  regard  to  the  general  circula- 
tion, bleeding  by  local  means  may  be  resorted  to. 

In  children  leeching  acts  as  a  general  bleeding. 

General  Rules  to  be  observed  in  relation  to  Bloodletting. — 
Always  bleed  a  patient  yourself,  or  at  any  rate  be  present  when  your  pa- 
tient is  bled. — The  reasons  of  this  are  obvious,  from  what  has  already 
been  said.     The  effects  of  bloodletting  differ  entirely  according  to  the 


SEDATIVKS.  205 

maimer  in  which  the  operation  is  performed — whether  by  a  large  or  a 
small  orifice,  whether  the  patient  be  sitting  up  or  lying  down,  &c.  &c. 
Now  all  this  can  only  be  properly  regulated  by  being  present.  With 
regard  to  the  quantity  of  blood  to  be  drawn  it  is  impossible  for  a  ph 
cian  to  say  d  priori  how  much  blood  requires  to  be  taken.  This  is  to 
be  judged  of  entirely  by  the  effect  at  the  time.  In  some  countries,  and 
I  am  sorry  to  say  in  some  parts  of  this  country,  the  operation  of  blood- 
letting is  trusted  to  a  distinct  class  of  men — a  regulation  more  objec- 
tionable and  dangerous  cannot  be  well  imagined.  [Bleeding  has  gone 
so  much  out  of  fashion  that  the  professional  bleeder  has  passed  away 
with  the  last  of  the  cocked  hats.]  Always,  then,  gentlemen,  carry 
your  lancet  with  you  and  perform  the  operation  yourselves.* 

In  bleeding  have  special  regard  to  the  orifice  which  you  make.  Tri- 
fling as  this  direction  may  appear,  it  is  nevertheless  of  the  very  greatest 
importance — and  the  reason  is  obvious,  from  the  difference  of  effect 
produced  by  the  drawing  of  blood  from  a  large  and  a  small  orifice.  As 
a  general  rule,  in  all  cases  there  ought  to  be  a  good-sized  orifice  made. 
Otherwise  you  will  not  obtain  all  the  advantages  to  be  derived  from 
general  bloodletting.  In  all  cases  determine  precisely  what  your  object 
is  in  drawing  blood.  Unless  you  do  this,  you  never  can  direct  your 
bleeding  in  such  a  way  as  to  attain  this  object  in  the  best  possible  man- 
ner. When  blood  is  flowing,  feel  the  pulse  of  your  patient.  As  the 
object  in  drawing  blood  is  to  produce  a  certain  effect  and  not  merely  to 
take  a  certain  quantity,  this  is  to  be  judged  of  only  by  the  effect  pro- 
duced at  the  time.  In  bleeding  children,  the  greatest  caution  should  be 
observed  in  watching  the  effects.  The  best  plan  is  to  set  them  upright, 
and  if  any  paleness  of  the  countenance  or  faintishness  appears,  the  bleed- 
ing should  be  instantly  arrested.  This  rule  is  applicable,  whatever  be 
the  mode  of  abstracting  blood,  whether  by  venesection,  or  by  leeches,  or 
by  cups.  With  regard  to  leeches,  especially,  great  care  should  be  exer- 
cised. This  has  already  been  alluded  to,  but  it  cannot  be  too  frequently 
insisted  upon. 

The  kind  of  lancet  which  is  used  is  a  matter  not  altogether  unimport- 
ant. In  this  country  there  are  two  used — the  spring  lancet,  and  the 
ordinary  thumb  lancet.  [The  spring  lancet  may  also  be  numbered  with 
the  things  that  were.  It  is  never  used,  and  certainly  never  should  have 
been.] 

Practical  or  Therapeutical  Applications  of  Bloodletting. — 
Before  proceeding  to  notice  the  use  of  this  important  remedy  in  various 
diseases,  it  will  be  proper  to  state  the  different  modes  in  which  it  proves 

*  Until  recently  the  Edinburgh  College  of  Physicians  prohibited  their  fellows 
from  using  the  lancet  or  the  scalpel !  I 


296  MATERIA    MEDICA    AND   THEEAPEUTICS. 

curative.  It  diminishes  the  actual  quantity  of  blood  in  the  system.  In 
this  way  unnatural  fulness  of  the  general  vascular  system  as  well  as  local 
accumulation  of  the  blood  are  corrected.  It  changes  the  quality  of  the 
blood  itself,  diminishes  the  action  of  the  heart  and  arteries,  and  when 
carried  so  far  as  to  produce  syncope,  suspends  temporarily  the  action  of 
the  vascular  system.  In  this  way  excessive  and  morbid  action  of  that 
system  is  controlled.  It  impairs  the  energy  of  the  brain  and  nervous 
system,  and  relaxes  the  muscles  and  the  whole  system  of  capillaries. 

In  one  or  more  of  these  modes  does  bloodletting  exert  its  curative 
influence  in  various  diseases.  In  the  notice  which  I  shall  take  of  its 
application,  all  I  shall  attempt  will  be  to  give  a  few  leading  facts  and 
principles.  To  go  into  the  necessary  details  in  relation  to  each  individual 
disease  would  occupy  a  volume. 

Of  Fevers. —  The  general  principles  upon  which  the  use  of  blood- 
letting is  resorted  to  in  this  class  of  diseases  are  the  following. 

It  is  observed  as  a  matter  of  fact,  that  the  circulation  almost  always 
becomes  preternaturally  excited.  In  this  state  of  things  there  is  always 
more  or  less  danger  of  some  local  embarrassment.  Moreover  in  a  great 
majority  of  cases  of  fever,  local  embarrassments  take  place,  showing 
themselves  sometimes  in  the  shape  of  inflammation  either  of  the  brain 
or  of  the  viscera  of  the  thorax,  or  of  the  abdomen ;  in  other  cases,  in 
the  form  of  simple  engorgements  or  congestions  of  those  parts.  Now, 
in  the  management  of  fevers,  the  great  object  is  to  regulate  the  circula- 
tion, so  as  to  prevent,  if  possible,  any  local  embarrassments,  or  to 
counteract  and  subdue  them  when  they  occur  in  the  shape  of  inflamma- 
tion and  congestion. 

For  the  accomplishment  of  these  objects  bloodletting  is  mainly  used 
in  fever.  Simple  and  obvious  as  this  general  principle  would  seem  to 
be,  the  application  of  it  is  not  always  easy.  For  fever  presents  itself 
under  a  great  variety  of  forms  and  manifestations,  and  occurs  in  consti- 
tutions essentially  different  from  one  another,  under  different  circum- 
stances of  climate  and  temperature,  and  from  various  causes.  Now,  all 
these  circumstances  exert  an  essential  influence  over  the  general  charac- 
ter of  the  disease,  and  of  course  greatly  modify  the  treatment.  Again, 
the  same  fever  presents  itself  in  different  stages,  in  each  of  which 
the  treatment  must  necessarily  vary.  If  all  this  be  true  of  the  treat- 
ment generally,  it  must  be  so  in  an  especial  manner  of  a  remedy  so 
potent  as  bloodletting.  The  due  administration  of  this  remedy,  there- 
fore in  fevers,  requires  not  merely  a  knowledge  of  general  principles, 
but  practical  tact  and  extensive  experience  in  adapting  these  princi- 
ples to  individual  cases.  To  enter  a  little  more  into  detail,  let  us 
briefly  notice  the  different  forms  of  fever. 

Intermittent  Fever. — This  consists  of  two  remarkable  periods,  in  each 
of  which  the  system  is  in  an  entirely  different  condition — the  paroxysm 


SEDATIVES.  Jl/7 

and  the  intermission.  In  the  period  between  the  paroxysms,  the  inter 
mission,  all  febrile  action  has  disappeared^  and  the  system  ha  returned 
to  a  state  of  health,  with  the  exception  of  being  somewhal  d<  I  ilitatcd. 
In  the  simple  unprotracted  form  of  this  disease,  too,  no  local  obstruction 
now  exists.  Jn  this  period,  therefore,  bloodletting  is  not  required.  On 
the  contrary,  if  resorted  to,  it  might  prove  actually  injurious.  The  sys- 
tem is  already  debilitated  by  the  previous  paroxysm,  and  if  blood  r< 
abstracted  it  would  merely  add  to  the  existing;  debility,  and  probably 
render  the  system  more  liable  to  the  return  of  the  paroxysm.  Besides 
this,  it  is  to  be  recollected  that  in  the  state  of  partial  collapse  which 
succeeds  the  paroxysm,  the  loss  of  blood  cannot  be  borne  so  well  as 
under  other  circumstances.  During  the  intermission,  therefore,  as  a 
general  rule,  bloodletting  is  not  advisable. 

Let  us  now  see  if  bloodletting-  be  proper  in  the  paroxysm.  As  already 
stated,  our  great  object  in  the  use  of  bloodletting  in  fever  is  to  prevent 
or  to  subdue  local  engorgement  and  inflammation.  Now,  during  the 
paroxysm,  there  are  two  periods  when  these  local  embarrassments  occur 
— in  the  cold  stage  and  in  the  hot.  In  the  cold  stage  the  blood  retires 
from  the  surface  of  the  body,  and  all  the  internal  viscera  become  more 
or  less  congested.  This  applies  to  the  brain  as  well  as  to  the  viscera  of 
the  chest  and  abdomen.  In  the  hot  stage,  the  action  of  the  heart  and 
arteries  is  excessive,  and,  as  is  always  the  case  under  such  arterial  excite- 
ment, the  large  viscera  are  in  danger  of  congestion  and  even  inflamma- 
tion. In  some  cases  one  or  the  other  of  these  actually  takes  place.  In 
both  of  these  periods,  then,  that  state  of  system  is  present  which  may 
require  bloodletting.  It  is  not  to  be  inferred  from  this,  however,  that  it 
is  in  all  cases  necessary.  On  the  contrary,  in  ordinary  intermittent 
venesection  is  not  required.  The  paroxysm  is  of  short  duration,  and 
the  congestion  during  the  cold  stage,  and  the  excitement  during  the 
hot,  come  to  a  spontaneous,  speedy  crisis.  To  bleed  in  the  cold  stage, 
is  very  generally  not  merely  useless,  but  dangerous,*  and  if  at  all  prac- 
tised, the  only  proper  time  for  it  is  during  the  hot  stage. 

The  period  most  usually  selected  for  the  abstraction  of  blood  is  the 
hot  stage,  and  this  would  certainly  more  naturally  be  suggested  as  the 
most  appropriate.  The  great  vascular  excitement — the  heat  of  skin — the 
flush  of  countenance — the  tendency  to  cerebral  congestion — would  all 

*  Senac,  one  of  the  best  writers  on  intermittent  fever,  says,  "  But  such  has 
been  the  rashness  of  some  men,  that  they  have  ventured  to  open  a  vein  during 
the  cold  fit.  This  practice  is  unreasonable  and  dangerous.  "When  the  pulse  is 
so  depressed  as  to  be  almost  imperceptible ;  when  the  blood  scarcely  circulates : 
when  the  vital  principle  seems  to  be  already  overpowered,  what  benefit  is 
expected  from  bloodletting  ?  Can  it  be  had  recourse  to  without  danger  in  old 
persons,  as  such  are  sometimes  known  to  expire  under  the  violence  of  the  cold  fit '?" 
— Senac  on  Fever,  p.  196. 


298  MATERIA    MEDICA    AND    THERAPEUTICS. 

seem  to  point  to  it  as  the  period  when  depletion  was  most  requisite  and 
could  most  easily  be  borne. 

Memittent  Fever. — This  form  of  fever  is  marked  by  the  same  general 
phenomena  as  the  intermittent,  differing  only  in  degree.  It  has  a  cold 
stage,  a  hot  stage,  and  a  sweating  stage ;  all,  however,  less  marked  and 
distinct.  >  The  chill  is  less  severe — the  reaction  in  the  hot  stage  is  less 
full  and  developed,  and  the  sweating  is  partial  and  imperfect.  As, 
therefore,  the  fever  does  not  come  to  the  same  kind  of  crisis  as  in  the 
intermittent,  the  local  embarrassments  which  take  place  during  the 
cold  and  hot  stages  are  not  so  completely  relieved  as  they  are  in  the 
intermittent.  Hence  they  become  more  permanent  difficulties  and  are 
more  likely  to  run  into  actual  inflammation.  The  organs  more  espe- 
cially liable  to  this  are  the  brain,  stomach,  and  liver ;  all  of  which,  on 
dissection,  furnish  abundant  evidence  of  the  previous  existence  of  conges- 
tion or  inflammation. 

Such  being  the  difference  between  intermitting  and  remitting  fever 
the  general  inference  would  be  that  venesection  is  much  more  necessary 
in  the  latter  than  in  the  former.     And  such  is  in  reality  the  case. 

In  the  use  of  bloodletting  in  this  form  of  fever,  there  are  several  cir- 
cumstances of  importance  which  ought  to  be  kept  in  view. 

In  the  first  place,  the  earlier  in  the  disease  it  is  resorted  to  the  better. 
In  the  early  stages  it  reduces  excitement  and  relieves  local  embarrass- 
ments much  more  certainly  and  speedily  than  it  does  at  more  advanced 
periods. 

In  the  second  place,  it  is  to  be  borne  in  mind  that,  like  intermittent 
fever,  the  remittent  consists  of  paroxysms,  although  less  marked  and 
distinct ;  and,  as  a  general  rule,  the  best  period  for  drawing  blood  is  at 
the  height  of  the  paroxysm.  When  there  is  a  tendency  to  sweating  it 
should  be  avoided. 

In  the  third  place,  in  deciding  upon  the  quantity  of  blood  to  be 
abstracted,  the  best  general  rule  that  can  be  laid  down  is  to  be  governed 
by  the  effects  produced  at  the  time. 

In  the  last  place,  although  venesection  is  a  remedy  sometimes  neces- 
sary in  this  form  of  fever,  yet  it  is  not  invariably  so.  There  is  the  mild 
or  simple  fever,  the  inflammatory,  and  the  congestive.  In  the  first, 
venesection  is  not  required  ;  in  the  second,  it  becomes  essential ;  while 
in  the  third,  it  is  also  essential,  but  in  more  moderate  quantities,  and 
with  due  precautions  to  ensure  reaction. 

[The  practice  of  bleeding  in  miasmatic  fevers  has  so  generally  gone 
out  of  favor  that  I  have  abridged  very  much  Dr.  Beck's  remarks  upon 
it.  Even  thus  abridged  they  do  not  represent  the  present  state  of  pro- 
fessional opinion  among  us,  but  are  much  too  favorable  to  the  use  of  the 
remedy.] 

3.   Continued  Fever.  —  In  this  form  of  fever,  bloodletting  is  to  be 


HKDATIVKS.  299 

bad  recourse  to  upon  the  same  principles,  and  with  the  same  objeels  in 
view,  as  in  the  other  forms — to  moderare  general  excitement  and  to 
relieve  local  embarrassments.  As  continued  fever  differs  greatly  in  its 
type  by  the  cause  which  produces  it — by  the  season  of  the  year — by 
climate — by  the  peculiar  constitution  of  the  patient,  &C,  so  the  use  of 
this  remedy  may  be  modified  by  all  these  circumstances.  In  some  eases 
it  is  not  necessary ;  in  others  it  may  prove  actually  injurious,  while  in 
others  again  it  may  be  essential  to  save  life.  At  one  time  general  blood- 
letting may  be  required,  while  at  another  every  benefit  may  be  derived 
from  local  depletion.  All  this  can,  of  course,  only  be  decided  by  the 
peculiar  condition  of  the  patient  at  the  time,  and  by  the  presence  or 
absence  of  particular  symptoms. 

Affections  of  the  Head. — Before  proceeding  to  notice  the  application 
of  bloodletting  in  affections  of  the  head,  it  is  proper  to  recollect  what 
has  already  been  said  in  relation  to  the  circulation  in  the  brain  and  the 
effects  of  the  loss  of  blood  on  that  organ.  From  this,  it  would  seem 
that  the  quantity  of  blood  in  the  brain  in  the  ordinary  condition  of  that 
organ  is  always  very  much  the  same.  If  this  be  so,  it  may  be  asked 
how  can  bloodletting  effect  any  change  in  these  cases  ?  To  this  the 
answer  is  that,  although  the  actual  quantity  of  blood  in  the  brain  at  any 
given  moment  may  not  vary,  yet  there  may  be  and  are  other  conditions 
of  the  circulation  in  this  organ  which  indicate  how  the  condition  of  the 
brain  can  be  changed  by  bloodletting. 

The  relative  proportions  of  arterial  and  venous  blood  in  the  brain 
may  vary  greatly.  When  the  general  circulation  is  loaded,  the  brain 
may  be  gorged  with  venous  blood,  and  arterial  blood  find  no  entrance 
in  sufficient  quantity,  and  hence  stupor  may  supervene.  On  the  other 
hand,  when  the  system  is  drained  of  blood,  the  arterial  flow  of  blood 
upon  the  head  may  be  excessive  from  the  want  of  venous  distension  to 
retard  it ;  and  giddiness,  tinnitus  aurium,  and  throbbing  in  the  head 
may  arise  from  this  cause.*  In  the  first  of  these  cases,  the  loss  of  blood 
by  venesection  would  lessen  the  quantity  of  venous  blood  in  the  brain, 
which  loss  would  be  supplied  by  an  equivalent  quantity  of  arterial, 
thus  restoring  the  natural  and  healthy  proportions  of  the  two.  Here, 
then,  venesection  would  prove  salutary.  In  the  second  case,  that  in 
which  the  arterial  flow  of  blood  to  the  head  is  in  excess,  the  still  further 
'loss  of  blood  would  increase  the  difficulty  and  might  result  in  effusion. 
Here  bloodletting  would  be  injurious  and  a  different  course  of  treatment 
is  required. 

Although  the  actual  quantity  of  blood  in  the  brain  cannot  be 
changed,  yet  "  the  impetus  with  which  it  enters  and  the  degree  of  pres- 
sure it  exerts  on  the  nervous  matter,  is  liable  to  much  change,"f  and  in 

*  Mayo,  p.  135.  f  British  and  For.  Eev.  vol.  in.  p.  324. 

20 


300  MATERIA  MEDICA   AND   THERAPEUTICS. 

this  way  may  the  condition  and  functions  of  the  brain  be  materially 
altered.  When  the  impetus  of  the  blood  is  in  excess,  especially  if  some 
cause  should  at  the  same  time  operate  to  retard  the  exit  of  blood  from 
the  brain,  such  a  degree  of  pressure  may  be  excited  as  to  disturb  its 
functions  and  perhaps  give  rise  to  effusion.  In  this  case  bloodletting 
■would  operate  advantageously  by  lessening  the  impetus  of  the  blood, 
and  of  course  diminishing  the  pressure  on  the  brain. 

On  the  other  hand,  when  the  impetus  of  the  arterial  blood  is  suddenly 
lessened,  the  pressure  on  the  brain  is  so  much  diminished,  as  to  produce 
more  or  less  insensibility.  In  this  way  the  "  insensibility  of  syncope 
from  loss  of  blood,  from  the  erect  posture,  and  from  tapping  for  ascites," 
appears  to  be  produced.*  Now  in  this  case,  venesection  of  course  would 
be  injurious. 

Although  the  quantity  of  blood  in  the  brain  may  not  change,  the  dis- 
tribution of  the  blood  in  the  small  vessels  may.  This  is  the  case  where 
particular  parts  of  the  brain  are  in  a  state  of  inflammation.f  Where 
this  inflammation  is  acute,  it  is  accompanied  by  an  increased  impetus  of 
the  blood  to  the  head,  which  keeps  up  the  inflammatory  state  in  the 
brain.     By  venesection  this  impetus  is  lessened. 

Inflammations  of  the  Brain. — Inflammations  may  assail  either  the 
membranes  of  the  brain  or  the  substance  of  that  organ.  The  most 
accurate  observers  admit  that  it  is  not  possible  in  all  cases  to  distinguish 
between  the  two.  Dr.  Abercrombie  says,  "our  knowledge  of  this  sub- 
ject is  not  sufficiently  matured  to  enable  us  to  say  with  confidence  what 
symptoms  indicate  inflammation  of  the  substance  of  the  brain,  as  dis- 
tinguished from  inflammation  of  its  membranes ;  but  the  distinction  is 
not  of  much  practical  importance."^  Whatever  be  the  seat  of  acute 
inflammation  of  the  brain,  whether  in  the  membranes  or  the  substance, 
the  treatment  is  the  same,  the  only  difference  depending  on  the  severity 
of  the  inflammation. 

In  acute  inflammation  of  the  brain  there  can  be  no  doubt  about  the 
propriety  and  necessity  of  bloodletting ;  and  the  great  thing  to  be 
attended  to  is  to  draw  the  blood  in  such  a  way  as  to  make  the  most 
decided  and  prompt  impression.  For  this  purpose  it  should  be  taken 
from  a  large  orifice,  and  in  such  quantity  as  to  affect  the  pulse  until  it 
merely  flutters  under  the  finger,  or  until  syncope  is  produced.  This 
should  be  done,  of  course,  as  early  as  possible,  with  the  view  of  arrest- 
ing at  once  the  progress  of  disease,  and  preventing  the  inflammation  from 
terminating  in  effusion.  The  necessity  of  arresting  the  inflammation 
before  effusion  takes  place  must  be  apparent,  from  the  structure  of  the 
head.    When  inflammation  assails  those  structures  which  have  a  natural 

*  British  and  For.  Rev.  vol.  iii.  p.  325. 

f  Ibid.  vol.  iii.  p.  326.  %  On  the  Brain,  p.  26. 


skdativks,  801 

outlet,  effusion  to  a  certain  extent  may  be  Balutary,by  aiding  in  relieving 
the  inflammation.  This  is  the  case  when  the  mucous  membrane  are 
inflamed.  In  the  brain,  however,  then:  is  no  outlet  for  ;my  effusion,  ami 
iii  consequence  of  this,  when  it  does  occur,  it  is  generally  destructive. 
On  this  account,  it  is  so  important  to  prevent  this  termination,  and 
this  is  to  be  accomplished  by  early  and  copious  depletion,  as  one  of  the 
means.  In  the  repetition  of  the  bloodletting,  we  must  be  governed  by 
circumstances,  by  the  local  symptoms,  and  the  state  of  the  pulse. 
"  Sometimes  one,  sometimes  two,  three,  or  four  bleedings  will  be  neces- 
sary."* 

Some  difference  of  opinion  lias  existed  as  to  the  best  vessel  from  which 
to  abstract  the  blood.  As  a  general  rule,  in  adults,  every  purpose  can 
be  answered  by  taking  it  from  the  arm,  provided  the  orifice  be  large  and 
a  sufficient  quantity  be  taken.  In  children,  on  the  contrary,  a  much 
greater  effect  can  be  produced  by  opening  the  external  jugular,  and  in 
them  it  may  frequently  have  the  preference. 

When  the  force  of  the  disease  has  been  broken,  as  indicated  by  the 
state  of  the  pulse  and  other  symptoms,  local  bloodletting  may  be 
resorted  to,  if  necessary.  For  this  purpose  leeches  may  be  applied  to 
the  temples  or  behind  the  ears. 

In  relation  to  the  use  of  bloodletting,  there  are  two  things  worthy  of 
notice.  The  first  is,  that  everything  depends  upon  its  being  used  early, 
and  to  a  sufficient  extent  The  second,  that  to  secure  its  full  effect,  it 
must  be  aided  by  the  use  of  other  means ;  and  among  these,  none  are 
so  efficacious  as  active  purging  and  the  application  of  cold  to  the  head. 
With  regard  to  purging,  Dr.  Abercrombie  rnakqs  this  striking  remark. 
"  In  all  forms  of  this  disease  (inflammation  of  the  brain),  active  purging 
appears  to  be  the  remedy  from  which  we  find  the  most  satisfactory 
results;  and  although  bloodletting  is  never  to  be  neglected  in  the  earlier 
stages  of  the  disease,  my  own  conviction  is,  that  more  recoveries  from 
head  affections  of  the  most  alarming  aspect  take  place  under  the  use  of 
very  strong  purging,  than  under  any  other  mode  of  treatment."! 

Apoplexy.  —  Although  from  the  earliest  periods  bloodletting  in  apo- 
plexy has  been  sanctioned  by  the  general  consent  of  the  profession,  yet 
by  some  of  the  most  respectable  authorities  of  modern  times  the  practice 
has  been  deprecated.  Among  these  may  be  mentioned  Kirkland, 
Fothergill,  and  Heberden.J  It  is  certainly  not  to  be  used  indiscriminately 
here,  any  more  than  in  other  complaints,  and  it  depends  entirely  upon 
the  manner  in  which  it  is  used,  whether  it  proves  salutary  or  injurious. 
In  the  application  of  bloodletting,  the  important  practical  points  to  be 

*  Armstrong's  Practice,  p.  365. 
\  Diseases  of  the  Brain,  p.  174. 
X  See  Cooke  on  Nervous  Diseases,  p.  137. 


302  MATERIA   MEDICA   A5TD   THERAPEUTICS, 

determined  are,  the  period  when  it  ought  to  be  used,  and  the  extent  to 
which  it  should  be  carried. 

With  regard  to  the  period  best  suited  to  the  abstraction  of  blood,  it  is- 
of  the  utmost  importance  to  recollect  that  apoplectic  seizures  are  not 
always  attended  by  the  same  symptoms.  In  some  cases,  the  pulse  is 
full  and  strong,  and  the  countenance  flushed,  livid,  and  tumid,  while  in 
others  there  is  great  depression  of  the  vital  powers,  from  the  sudden 
shock  given  to  the  brain.  In  these  cases,  "  the  face  is  pale,  the  skin  and 
extremities  cold,  the  respiration  slow  and  difficult,  the  pulse  feeble  and 
frequent,  while  both  faeces  and  urine  may  be  discharged  involuntarily."* 
In  some  of  these  cases,  the  shock  given  may  be  so  great  that  the  system 
makes  no  effort  of  reaction,  while  in  others  reaction  gradually  takes 
place,  resembling  in  this  respect  ordinary  concussion  of  the  brain.  Now 
it  must  be  evident  that  in  these  two  conditions  of  the  system  the  same 
treatment  will  not  answer.  In  the  first,  prompt  depletion  may  at  once 
be  resorted  to  with  advantage ;  while  in  the  second,  the  effect  of  this 
treatment  would  be  to  depress  still  further  the  vital  powers,  and  to 
destroy  any  remaining  efforts  of  the  system  at  producing  reaction. 
Here,  therefore,  bloodletting  should  not  be  used  until  reaction  has  been 
insured  by  the  use  of  suitable  stimulants,  external  and  internal.  After 
this  has  been  accomplished  blood  may  be  taken. 

With  regard  to  the  extent  to  which  the  blood  should  be  taken,  this 
must  be  determined  entirely  by  existing  symptoms.  When  the  patient 
is  strong,  full  habited,  with  the  pulse  full  and  hard,  the  face  flushed, 
head  hot,  and  no  paralysis  is  present,  bleeding  may  be  freely  practised 
until  a  suitable  impression  is  made  on  the  pulse.  On  the  other  hand,  if 
the  patient  be  not  strong  or  full  habited,  if  the  pulse  be  feeble,  the  face 
not  flushed,  and  the  head  has  little  heat  about  it,  depletion  must  be 
practised  with  more  caution  ;  and  in  many  cases  local  bleeding  [or  purg- 
ing and  cold  to  the  head]  may  be  advantageously  substituted.  Of  the 
means  used  for  local  depletion,  cups  would  seem  to  be  decidedly  prefer- 
able to  leeches.  They  take  the  blood  more  promptly,  at  the  same  time 
that  they  make  a  salutary  impression  on  the  brain,  by  the  irritation 
which  they  occasion.  Patients  frequently  show  evidence  of  returning 
sensibility  during  the  operation  of  cupping.  The  best  places  for  apply- 
ing them  are  the  temples,  the  nape  of  the  neck,  or  between  the  shoulders. 

From  the  foregoing  the  conclusion  is  obvious  that,  although  blood- 
letting is  a  remedy  of  great  value  in  these  cases,  it  must  be  used  with 
caution  and  certain  restrictions,  or  it  may  do  more  harm  than  good,  by 
exhausting  and  prostrating  the  system.  Nothing,  therefore,  can  be  more 
irrational  than  the  too  common  practice  of  flying  at  once  to  the  lancet 
in  all  cases  of  this  kind.    [The  following  extract  from  Dr.  Todd  embodies 

*  Dewees,  vol.  i.  p.  213.     See  Copland,  pp.  100  and  102. 


bKlMTlVHK.  803 

the  true  idea  of  the  cure  of  apoplexy.  "  The  majority  of  case*  of  apo- 
plexy are  best  treated  by  purging,  shaving  the  head,  and  keeping  it 

cool,  perhaps  blistering;  for  bleeding  is  rarely  applicable,  except  l<>  tbe 
young,  vigorous,  strong,  and  plethoric."] 

Hydrocephalus  Internus. — Although  formerly  considered  as  a  mere 
dropsy  this  opinion  is  at  present  very  generally  abandoned.  Modern 
researches  have  shown  that  in  this  disease  the  effusion,  so  far  from  con- 
stituting the  disease  itself  is  merely  one  of  the  consequences  of  an  ante- 
cedent morbid  affection  of  the  brain.  ]>y  Abercrombie  the  following 
important  points  would  seem  also  to  be  established. 

"  1st.  That  in  the  ordinary  cases  of  hydrocephalus,  the  coma  and 
other  symptoms  attending  it  are  not  to  be  considered  as  the  direct 
effect  of  the  effusion,  but  of  that  morbid  condition  of  the  brain  of  whieh 
the  effusion  is  the  consequence. 

"  2d.  That  we  have  no  certain  mark  which  we  can  rely  upon  as  indi- 
cating the  presence  of  effusion  in  the  brain,  as  slowness  of  the  pulse 
followed  by  frequency,  squinting,  double  vision,  dilated  pupil,  paralytic 
symptoms,  and  perfect  coma,  have  been  seen  to  exist  without  any 
effusion." 

That  all  these  symptoms  may  exist  in  connexion  with  a  state  of  the 
brain  which  is  simply  inflammatory.*  It  would  seem  that  acute  hydro- 
cephalus may  be  considered  as  a  disease  "  common  in  infancy,  yet 
occurring  occasionally  later  in  life,  the  nature  of  which  is  inflammation 
of  the  brain  and  its  membranes,  with  a  tendency  to  terminate  in  serous 
effusion.  The  disease  is  characterized  by  a  combination  of  all  or  several 
of  these  symptoms — pain  in  the  head,  sensibility  to  light,  restlessness, 
starting  from  sleep  and  screaming,  squinting,  convulsions,  dilation  of 
the  pupils,  coma."f 

If  such  be  the  nature  of  this  disease,  not  merely  is  the  propriety  of 
bloodletting  evident,  but  the  limits  also  which  should  be  put  to  it 
equally  so.  During  the  early  stage  both  general  and  local  bloodletting 
may  be  used  with  advantage  for  the  purpose  of  arresting  the  inflamma- 
tory action  of  the  brain.  As  in  all  other  cases  the  quantity  to  be  ab- 
stracted must  be  regulated  by  the  age  of  the  patient,  the  severity  of  the 
local  symptoms,  and  the  state  of  the  pulse.  In  the  second  stage,  when 
there  is  reason  to  believe  that  effusion  has  taken  plaee,  the  abstraction 
of  blood  would  be  injurious,  as  it  would  increase  the  tendency  to  effu- 
sion. Although,  therefore,  there  can  be  no  doutt  that  in  acute  hydro- 
cephalus bloodletting  is  a  proper  remedy,  yet  it  is  to  be  recollected  that 
symptoms  analogous  to  those  which  characterize  this  disease  frequently 
exist  without  any  inflammation — arising,  in  fact,  from  a  condition  of 
things  entirely  different,  viz.  the  want  of  nervous  energy,  the  result  ot 

*  Abercrombie  on  the  Brain,  p.  166  f  ilajo.  p.  165. 


304  MATERIA   HEDICA  AND   THERAPEUTICS. 

debilitating  and  prostrating  causes.  This  is  a  form  of  disease  which 
has  been  investigated  with  great  skill  by  Drs.  Abercrombie,  Hall,  and 
Gooch,  and  which  is  admirably  described  by  the  latter.  It  is  chiefly 
indicated  by  "heaviness  of  head  and  drowsiness,  without  any  signs  of 
pain,  great  languor,  and  a  total  absence  of  all  active  febrile  symptoms."*' 
If  patients  with  these  symptoms  be  treated  upon  the  supposition  of  its 
being  inflammation,  they  gradually  get  worse  and  die  from  exhaustion, 
and  in  some  cases  towards  the  last  "  with  symptoms  of  oppressed  brain, 
as  coma,  stertorous  breathing,  and  dilated  and  motionless  pupil."f  On 
opening  the  head  after  death,  "the  bloodvessels  were  unusually  empty, 
and  the  fluid  in  the  ventricles  rather  in  excess;  in  two  instances  death 
was  preceded  by  symptoms  of  effusion,  viz.  blindness,  dilated  pupil, 
coma,  and  convulsions;  and  after  death  the  ventricles  were  found  dis- 
tended with  fluid  to  the  amount  of  several  ounces,  the  sinuses  and  veins- 
of  the  brain  being  remarkably  empty  ."J  In  these  cases  Dr.  Gooch 
very  justly  infers,  "this  sudden  effusion  was  a  passive  exudation  from 
the  exhalants  of  the  ventricles  occasioned  by  a  state  of  the  circulation 
the  very  opposite  to  congestion  or  inflammation. "§ 

Now,  it  must  be  evident  that  the  mode  of  treatment  here  must  be 
very  different  from  that  pursued  in  inflammation.  Instead  of  depletion, 
purging,  <&c,  remedies  of  a  supporting  character  must  be  resorted  to- 
Gooch  and  Hall  relate  a  number  of  cases  in  which  wine,  ammonia,  &c, 
have  been  successful  in  curing  the  disease. 

For  the  diagnosis  see  Hall,  Gooch,  Abercrombie,  <fcc. 

Besides  the  forms  of  hydrocephalus  already  noticed  there  is  no  doubt 
that  a  sudden  effusion  may  take  place  in  children  without  inflammation. 
See  Warren  on  the  Head. 

Mania. — In  this  disease  the  use  of  bloodletting  has  given  rise  to- 
much  difference  of  opinion.  The  practice  of  Sydenham  was  to  take 
away  eight  or  nine  ounces  of  blood  from  the  arm  in  young  subjects,  and 
repeat  the  operation  twice  or  thrice,  at  the  distance  of  three  days  be- 
tween each  bleeding,  and  then  bleed  once  from  the  jugular.  After 
this,  the  cure  was  to  be  trusted  to  purgatives.||  Improving  upon  the 
practice  of  Sydenham,  by  others,  bloodletting  was  carried  to  the  most 
extravagant  length.  Plater  states  that  he  bled  once  a  week,  and  had 
done  so  in  a  case  for  seventy  successive  weeks.^[  Rush  says,  "bleed- 
ing is  here  more  necessary  than  in  any  other  disease,  and  must  be  car- 
ried further."  He  gives  cases  in  which  he  took  in  one,  200,  and  in  the 
other,  470  ounces,  at  forty-seven  different  bleedings.*1  On  the  other- 
hand,  Ferriar,  an  excellent  authority,  though   he   sanctions  moderate 

*  Gooch,  p.  311.  f  Ibid.  p.  312.  %  Ibid.  p.  319.  §  Ibid.  p.  320. 

||  Works,  p.  462.         \  Observat.  lib.  i.  p.  86.  (Burrows,  p.  588.) 
*'  On  the  Mind,  p.  190. 


BEDATIVES.  SOS 

bleedings,  says  that  repeated  bleedings,  though  advised  by  Sydenham, 
arc  hazardous.*  By  Willis,  bleedings  both  general  and  local  are  con- 
demned; and  Burrows  s;iys  he  did  not  "  order  venesection  in  six  cases 
of  simple  mania  in  as  many  years."f 

From  the  conflicting  authorities,  it  is  quite  evident  that  the  abstrac- 
tion of  blood  in  mania  is  a  point  of  practice  which  requires  great  judg- 
ment and  discrimination,  and  nothing  can  be  more  injurious  than  the 
wholesale  practice  of  depletion  which  was  formerly  in  vogue.  In  Borne 
cases,  however,  bloodletting  cautiously  used  may  be  advantageous.  Ac- 
cording to  Burrows,  the  only  cases  in  which  general  bloodletting  can 
be  justified  in  mental  derangement,  are  those  in  which  there  exists  a 
state  of  plethora,  or  where  apoplexy  is  pending.J  As  a  general  rule, 
bleeding  should  only  be  resorted  to  when  the  pulse  is  hard  and  tense, 
and  high  excitement  is  present.  [Never  bleed  an  insane  person  unless 
symptoms  are  present  which  would  justify  bleeding  if  the  patient  were 
sane,  that  is  to  say,  never  bleed  for  mental  excitement  however  violent.] 

Although  general  bleeding  should  be  used  with  great  reserve,  yet 
local  may  be  resorted  to  with  perfect  safety  and  advantage,  either  by 
cups  or  leeches  applied  to  the  head,  nape  of  the  neck,  or  between  the 
shoulders.     The  quantity  of  course  to  be  regulated  by  circumstances. 

Inflammation  of  the  Throat  and  Air  Passages. — Tonsillitis. — It  is  not 
in  every  case  of  this  disease  that  bleeding,  either  general  or  local,  is 
necessary.  In  many  cases,  however,  it  is  essential,  and  the  use  of  it 
must  be  governed  by  the  symptoms  which  are  present.  If  the  local  in- 
flammation and  tumor  be  great,  if  there  be  much  febrile  excitement,  and 
if  with  these  the  patient  be  full  habited  and  strong,  the  propriety  of 
general  bloodletting  cannot  be  questioned.  This  may  be  followed  by 
the  application  of  leeches  to  the  throat.  Bloodletting  in  this  complaint 
is  advisable,  not  merely  to  aid  in  subduing  directly  inflammatory  action, 
but  also  to  prevent  any  bad  effects  from  the  use  of  emetics,  should  they 
be  deemed  necessary.  In  all  cases  of  tonsillitis,  where  the  disease  is 
acute  and  the  habit  full,  there  is  necessarily  a  great  accumulation  of 
blood  about  the  head  ;  and  if  under  these  circumstances  emetics  were 
given,  permanent  injury  to  the  brain  might  result.  In  those  cases  where 
the  habit  of  the  patient  is  weak,  and  the  constitutional  excitement  mo- 
derate, local  depletion  answers  a  much  better  purpose  than  general. 

Among  the  modes  of  local  depletion  that  of  scarifying  the  tonsils  is 
the  simplest  and  most  efficacious.  Cupping  on  the  back  of  the  neck  or 
behind  the  ears  may  also  be  used  with  effect.  The  most  common  mode, 
however,  is  to  apply  leeches  to  the  throat. 

Laryngitis. — As  this  is  a  form  of  inflammation  which  runs  its  course 
with   overwhelming  rapidity,   it  is  necessary  that  any  remedies  which 

*  Ferriar,  p.  181.  f  Burrows,  p.  583.  \  Burrows,  p.  585. 


306  MATERIA  MEDIC  A  AND   THERAPEUTICS. 

may  be  used  to  arrest  it  should  operate  with  the  greatest  possible 
promptness  and  power.  Among  these  bloodletting  and  emetics  must 
necessarily  take  the  lead.  They  act  with  great  promptitude,  and  if  pro- 
perly administered  are  capable  of  producing  the  best  effects  on  the  sys- 
tem. When  the  symptoms  are  urgent,  the  first  remedy  should  be  blood- 
letting from  the  arm,  and  it  should  be  used  not  so  much  to  take  away  a 
certain  amount  of  blood  as  to  produce  a  certain  effect — syncope.  Un- 
less this  is  done,  bloodletting  can  do  little  or  no  good.  The  blood,  there- 
fore, should  be  taken  from  a  large  orifice,  the  patient  in  a  standing  or 
sitting  position.  After  this  a  copious  supply  of  leeches  should  be  applied 
over  the  larynx.  By  some  authorities  bloodletting  is  not  esteemed  a 
remedy  of  great  value  in  this  complaint.  Dr.  Armstrong  says,  "  it  exer- 
cises, upon  the  whole,  less  influence  over  this  than  any  other  form  of  in- 
flammation."* And  he  relates  two  cases  in  which  the  abstraction  of 
blood  was  carried  to  a  great  extent  without  any  relief,  both  patients 
dying.  It  cannot  be  denied  that  there  is  much  truth  in  this  statement, 
and  the  same  may  be  said  of  every  remedy  resorted  to.  The  danger  in 
this  complaint  does  not  arise  from  the  extent  of  inflammation,  but  from 
the  peculiar  location  of  it  in  a  part  essential  to  life.  The  inflammation 
produces  a  speedy  thickening  or  effusion,  which  has  the  effect  of  obstruct- 
ing the  passage  of  air  into  the  lungs,  and  in  consequence  of  which  the 
patient  dies  from  suffocation.  It  is  then  the  organic  change  which  takes 
place  consequent  upon  the  inflammation  rather  than  the  inflammation 
itself  which  constitutes  the  danger ;  and  this  change  takes  place  with 
such  rapidity  as  to  leave  but  little  time  for  action.  It  is  hardty  surpris- 
ing that  bloodletting  as  well  as  all  other  remedies  should  frequently 
prove  so  unavailing.  Nevertheless  bloodletting,  if  used  at  the  proper 
period  and  carried  to  a  sufficient  extent,  has  in  many  cases  proved  of 
evident  advantage.f  In  the  early  state  of  this  disease,  when  the  chief 
symptoms  are  pain  and  constriction  in  the  larynx,  and  when  the  strength 
of  the  system  is  unbroken,  free  depletion  may  be  exceedingly  beneficial- 
On  the  other  hand,  when  organic  changes  have  already  taken  place  in 
the  larynx  and  the  patient  is  beginning  to  suffer  from  the  effects  of  im- 
peded respiration  and  a  want  of  due  arterialization  of  the  blood,  when 
the  strength  is  failing,  the  countenance  becoming  waxy  or  livid,  and  the 
lips  pale,  it  is  very  evident  that  bloodletting,  so  far  from  doing  good, 
mav  do  much  injury  by  still  further  impairing  the  powers  of  life.  In 
this  case  nothing  but  tracheotomy  can  be  of  any  service. 

Notwithstanding  that  I  look  upon  bloodletting  as  so  importaut  an 
agent  in  this  disease,  it  is  to  be  recollected  that  it  is  only  the  first  of  a 
series  of  other  agents  which  are  to  be  used  to  effect  a  cure.     It  may 

*  Lectures,  p.  382. 

f  See  Cheyne  (in  Stokes  on  Diseases  of  the  Chest),  p.  156. 


SEDATIVES.  307 

mala:  a  first  and  very  salutary  impression  on  the  disease,  but  this  require  to 
be  properly  sustained  by  the  use  of  emetics,  cathartic  .  blisters,  and  calomel. 

Trachilis. —  In   speaking  of  this  disease   under  the   head  of  em<  ' 

mentioned  (hat  if  taken  in  the  early  stage,  before  the  local  inflammation 
is  fully  established,  and  before  general  inflammatory  action  is  excited,  it 
may  readily  be  broken  up  by  the  judicious  use  of  emetics  and  other 
agents  without  having  recourse  to  bloodletting.  When,  however,  thi 
period  has  passed  by,  and  the  disease  becomes  decidedly  inflammatory 
in  its  character,  this  will  not  answer,  and  more  active  remedies  must  be 
resorted  to.  As  this  disease  runs  its  course  in  a  short  time  and  Bpeedily 
terminates  in  the  formation  of  a  false  membrane,  the  great  object  is  to 
prevent  this  by  the  use  of  such  means  as  shall  at  once  arrest  the  inflam- 
matory action.  To  accomplish  this  object  no  remedy  acts  with  such 
efficiency  as  bloodletting.  General  experience  has  established  the  fact, 
that,  if  properly  used,  it  exercises  a  wonderful  control  over  this  form  of 
inflammation.  The  period  proper  for  the  use  of  the  lancet  is  that  in 
which  active  inflammation  is  present — when  this  has  terminated  in  effu- 
sion and  in  the  formation  of*  a  false  membrane,  the  only  effect  of  bleed- 
ing will  be  to  hasten  death.*  Much  difference  of  opinion  has  existed 
with  regard  to  the  extent  to  which  bloodletting  should  be  carried.  It  is 
impossible  to  fix  upon  any  precise  quantity  as  suitable  in  all  cases.  As 
the  object  is  to  produce  a  decided  impression  on  the  symptoms,  bleeding 
ought  to  be  continued  until  the  pulse  flutters  under  the  finger  or  to  ap- 
proaching syncope.f  Actual  syncope  should  be  avoided  for  the  reasons 
already  stated.  In  very  young  subjects  this  is  the  practice  which  has 
received  the  sanction  of  the  best  observers,  and  which  has  been  attended 
by  the  most  decided  success.  See  Armstrong's  Lectures,  Stokes, 
Dewees,  Eberle,  Mackintosh,  Hosack.  With  regard  to  the  mode  of  ab- 
stracting blood,  as  a  general  rule,  venesection  is  preferable  to  local  bleed- 
ing, inasmuch  as  it  makes  a  more  prompt  and  decided  impression.  The 
best  place  to  take  the  blood  from  is  the  arm,  when  the  veins  are  large 
enough  to  admit  of  it.  When  this  is  not  the  case,  it  may  be  taken  from 
the  veins  on  the  back  of  the  hand.  By  some  the  jugular  vein  is  pre- 
ferred. Blood  may  be  readily  taken  from  this  vessel,  but  the  objection 
to  it  is  the  difficulty  of  controlling  the  hemorrhage  from  the  orifice.  The 
coughing  and  vomiting,  if  emetics  should  be  given,  will  be  very  apt  to 
open  the  orifice,  and  thus  do  mischief.^ 

Inflammation  of  the  Lungs. — Inflammation  may  assail  either  the 
mucous  membrane  of  these  organs,  or  the  parenchymatous  substance, 
or  the  investing  membrane.  Although  in  all  of  them  bloodletting  may 
be  required,  yet  there  is  a  difference  in  the  extent  to  which  it  may  be 

*  For  cases  see  Mackintosh,  p.  280. 

f  As  a  general  rule  Armstrong  recommends  §  ij  from  an  infant  a  year  old,  four 
from  one  to  two  years  old,  six  from  one  to  three  years  old     Lectures,  386. 
\  See  Stokes  on  Chest,  p.  146. 


308  MATERIA   MEDICA  AND   THERAPEUTICS. 

carried.     This  shows  the  importance  of  accurately  distinguishing  the 
precise  seat  of  inflammation. 

With  regard  to  the  utility  of  bloodletting  in  bronchitis,  there  is  a  differ- 
ence of  opinion.  Laennec  says,  "  although  there  is  an  inflammation  of 
the  mucous  membrane  of  the  lungs,  bleeding  is  rarely  useful  in  it, 
except  in"  very  robust  subjects,  or  where  the  symptoms  are  so  severe  as 
to  threaten  peripneumony,  or  where  there  is  blood  in  the  expectoration." 
Accordingly,  this  measure,  with  the  exception  just  named,  has  always 
been  rejected  by  good  practitioners,  as  rendering  the  disease  of  longer 
duration,  and  in  diminishing  and  sometimes  checking  the  expectoration. 

Bleeding  then  is  a  remedy  which  cannot  be  used  with  the  same  free- 
dom in  this  form  of  inflammation  as  in  many  others. 

In  Pneumonia. — This  is  one  of  the  diseases  over  which  bleeding 
exerts  the  most  decided  curative  influence.  It  is  sanctioned  by  the 
almost  universal  consent  of  practitioners,  both  ancient  and  modern.  M. 
Louis  is  the  only  exception,  and  to  his  opinion  that  this  remedy  exer- 
cises but  little  control  over  pneumonia,  I  allude  only  to  prevent  your 
being  misled  by  it.  Bleeding  is  in  this  disease  the  sheet  anchor.  But, 
here,  much  of  the  effect  of  the  remedy  will  depend  on  the  mode  in 
which  it  is  used.  The  rule  is  the  same  to  which  I  have  alluded  in 
other  inflammations,  "  bleed  early"  Besides  general  bleeding,  advan- 
tage may  often  be  derived  from  cupping,  or  in  young  subjects  leeching. 
If,  as  is  very  common,  the  inflammation  affect  the  root  of  the  lung,  it  is 
a  very  good  practice  to  apply  cups  over  the  posterior  part  of  the 
chest,  and  afterwards  let  the  patient  lie  down  under  a  large  bran 
poultice.  This  is  the  way  in  which  bleeding  should  be  practised  if  we 
see  the  patient  in  the  first  stage.  In  the  second  stage  the  remedy  can 
by  no  means  be  used  with  the  same  freedom ;  nor,  where  its  moderate 
use  is  admissible,  is  it  at  all  likely  to  do  the  same  amount  of  good. 
Still,  if  the  patient  have  some  vigor — if  the  second  stage  has  not 
advanced  very  far — if  considerable  sound  lung  still  remain,  a  moderate 
bleeding  will  have  a  good  effect;  or  cups  may  be  used  as  before  directed. 

Puerperal  Fever. — This  is  sometimes  called  Puerperal  Peritonitis,  or 
as  proposed  by  Dr.  Gooch,  Peritoneal  Fever.  It  begins  a  few  days 
after  delivery,  and  its  characteristic  symptoms  are  pain  and  tenderness 
over  the  abdomen,  and  general  fever,  and  a  rapid  pulse.  When  it 
terminates  fatally  it  does  so  generally  about  the  fifth  day,  and  frequently 
much  sooner.  On  dissection,  it  is  found  that  violent  inflammation  of 
the  peritoneal  and  pelvic  viscera  has  taken  place,  terminating  in  effusions 
of  serum,  lymph,  and  sometimes  blood. 

With  regard  to  the  treatment,  although  at  one  time  great  diversity 
of  sentiment  prevailed,  yet  modern  practitioners  generally  concur  in  the 
propriety  and  necessity  of  bloodletting  as  an  essential  remedy.  In  the 
use  of  this  remedy,  however,  everything  depends  upon  the  manner  in 
■which  it  is  applied  [and  on  the  type  of  the  fever].     From  the  severity 


SEDATIVES.  809 

of  the  inflammation  and  the  rapidity  of  its  course,  it  is  evident  tlial  to 
do  any  good  it  must  be  used  very  early  in  the  disease.  If,  on  the  other 
hand,  it  be  not  used  until  the  disease  lias  advanced  to  a  certain  period, 
the  only  effect  will  be  to  prostrate  the  general  powers  of  the  system, 
without  at  all  affecting  the  local  inflammation;  an  analysis  of  the 
various  cases  in  which  venesection  lias  been  used  will,  I  think,  fully 
substantiate  the  correctness  of  this  statement.  The  application,  then, 
of  this  remedy,  is  a  matter  of  some  nicety,  and  involves  several  points  of 
great  practical  importance  ?  What  is  the  proper  period  for  depletion  ?  To 
what  extent  is  it  to  be  carried  ?    At  what  period  docs  it  become  injurious? 

1.  What  is  the  proper  period  for  depletion? — I  have  already  said  that 
to  doTiny  good,  the  bleeding  should  be  resorted  to  early. 

It  is  only  in  the  first  stage,  or  the  stage  of  excitement,  that  venesection 
can  be  proper.  In  the  second,  or  that  of  collapse,  the  only  effect  is  to 
sink  the  remaining  powers  of  life.  The  best  general  rule,  then,  that  can 
be  adopted  is  to  bleed  as  early  as  possible  in  the  disease.  To  what 
extent  should  the  bleeding  be  carried  ?  This  is  a  point  on  which  a  great 
difference  of  opinion  has  existed.  By  some  a  specific  quantity  of  blood 
is  directed  to  be  taken  away.  The  practice  recommended  by  Baude- 
locque  is  to  take  away  twelve  ounces  of  blood  at  first.  This  is  what  he 
calls  an  experimental  bleeding.  When  this  bleeding  procures  but  little 
relief,  if  the  pulse  should  continue  hard  and  corded,  and  not  increased 
in  frequency,  he  repeats  a  more  copious  bleeding  at  a  short  interval,  and 
after  a  few  hours  a  third,  if  necessary.  On  the  contrary,  if  after  the  first 
bleeding  the  pulse  becomes  more  frequent,  soft,  and  smaller,  at  the 
same  time  that  the  pain  and  swelling  of  the  abdomen  increase,  he  is 
cautious  about  repeating  it.  Armstrong  recommends  that  the  patient 
should  be  bled  without  regard  to  the  quantity  of  blood,  to  approaching 
syncope,  "  until  the  pulse  completely  falters,  the  face  becomes  pale,  and 
the  hands  drop  by  the  side."  As  soon  as  the  patient  recovers  from  the 
syncope,  he  gives  him  three  grains  of  opium,  or  120  drops  of  the  tinct. 
of  opium.  In  the  course  of  two  or  three,  or  at  furthest  four  hours,  if 
pain  and  fever  be  still  present,  he  bleeds  again  to  approaching  syn- 
cope, and  after  this  two  of  opium  with  three  grains  of  calomel.  If  the 
pain  and  fever  still  continue,  a  similar  bleeding  is  repeated  after  two  or 
three  hours,  followed  by  a  grain  and  a  half  of  opium,  with  three  grains 
of  calomel.  Generally  he  states  that  a  third  bleeding  was  not  neces- 
sary, and  that  where  he  was  called  early,  this  practice  succeeded  in 
nineteen  cases  out  of  twenty.  Where  any  slight  degree  of  inflammation 
remains  after  this,  leeches  may  be  applied.* 

Gooch's  practice  was,  if  called  a  few  hours  after  the  attack,  to  bleed 
from  a  large  orifice  till  the  patient  felt  faint.  The  arm  was  then  tied  up, 
and  the  head  raised,  so  as  to  encourage  the  faintness  for  many  minutes. 

*  Practice,  p.  645. 


310  MATERIA    MEDICA    AND   THERAPEUTICS. 

As  soon  as  the  faintness  subsided,  from  ten  to  twenty  grains  of  calomel 
were  given,  and  after  this  half  an  ounce  of  sulphate  of  magnesia,  every 
other  hour,  until  the  bowels  were  freely  acted  on.  When  faintness  had 
entirely  gone  off,  from  ten  to  twenty  leeches  were  applied  to  the  tender 
parts  of  the  abdomen,  and  after  they  had  fallen  off,  a  large  bran  poul- 
tice was  applied  to  the  abdomen,  to  keep  up  the  bleeding,  and  act  as  a 
fomentation  to  the  parts.  He  waited  now  till  the  cathartic  had  operated 
freely  and  frequently,  and  the  state  in  which  he  then  found  the  patient 
determined  him  as  to  a  second  bleeding.  If  the  abdomen  was  still  pain- 
ful and  tender,  and  the  pulse,  retained  any  of  its  hardness  or  incompres- 
sibility,  or  if  the  pulse  was  not  so  weak  as  to  forbid  general  bleeding,  it 
was  again  repeated  to  faintness.  On  the  contrary,  if  the  pulse  was  small 
and  weak,  and  only  soreness  remained,  leeches  were  applied.  This  treat- 
ment, he  says,  generally  arrested  the  disease.  The  period  during  which 
this  treatment  is  admissible,  he  limits  to  the  first  day,  in  "  which  it 
should  be  begun  and  ended." 

Is  Bloodletting  a  Remedy  applicable  in  all  cases  ? — This  is  the  opinion 
of  some.  Baudelocque  limits  the  use  of  it  to  sporadic  peritonitis ;  where 
it  is  epidemical,  especially  in  hospitals,  he  thinks  it  injurious.  On  this 
point  Dr.  Gooch  has  stated  some  invaluable  facts,  and  he  has  shown 
that  there  are  a  class  of  cases  in  which  bleeding  is  not  a  proper  remedy. 
In  several  cases  which  he  records,  in  which  death  supervened  in  two  or 
three  days,  no  appearance  of  inflammation  in  the  peritoneum  could  be 
detected,  neither  redness,  adhesion,  nor  effusion  of  any  kind.  He  thinks 
this  form  of  the  disease  occurs  in  delicate  and  nervous  habits,  "  when 
the  pain  and  tenderness  have  followed  an  irritable  cause,  such  as  severe 
after  pains  or  a  griping  purge — when  the  pulse,  although  quick,  is  per- 
fectly soft  and  even  weak.  The  mode  of  treating  these  cases  is  by 
opiates  (10  grs.  of  Dover's  powders  every  three  hours  till  the  pain  is 
gone),  large  poultices,  and  sometimes  leeches  to  the  abdomen.* 

TARTAR    EMETIC. 

Of  this  important  remedy  I  have  spoken  more  than  once,  yet  its 
influence  as  a  sedative  is  too  often  essential  in  the  treatment  of  disease 
to  allow  me  to  pass  it  by.  Of  its  action  as  an  emetic  I  have  spoken  at 
large.     But  independently  of  this,  tartarized  antimony  exerts  an  influ- 

*  As  illustrating  the  extent  to  which  bleeding  has  "  gone  out  of  fashion,"  the 
following  fact  was  communicated  to  me  by  a  leading  hospital  physician.  He 
one  day  found  in  his  wards  a  stout  girl  with  single  pneumonia.  He  remarked  to 
the  walker,  "  This  is  one  of  those  rare  cases  which  will  bear  bleeding.  Let  her 
lose  a  pint  of  blood."  The  young  gentleman  hesitating,  the  Doctor  asked :  "  Have 
you  ever  bled  a  patient?"  il  No,  sir."  "  Ever  seen  one  bled?"  "No."  "Have 
you  a  lancet?"  "No."  "  Well,  I  have  not  either;  but  I  suppose  some  of  the  young 
men  may  have  one."  On  inquiry  it  was  found  that  of  the  twelve  internes  not  one 
had  a  lancet — not  one  had  ever  seen  a  patient  bled. — C.  R.  G. 


KKUA'irVKS.  '.',\  I 

encc  over  the  vital  powers,  and  especially  over  the  circulation;  if,  dimi- 
nishes tlie  action  of  the  heart  and  arteries,  and  operates  us  a  direct  and 

most  powerful  sedative.  As  such  it,  is  used  every  day  in  practice,  and 
it  is  of  course  very  important  that  you  should  be  aware  <>f  the  nature  of 
its  powers,  and  of  the  best  way  in  which  to  avail  yourselves  of  them  in 
the  treatment  of  disease. 

With  regard  to  the  mode  in  which  tartar  emetic  produces  its  sedative 
effects,  there  has  been  much  difference  of  opinion.  By  some  it  has 
been  supposed  to  be  merely  the  result  of  the  nausea  and  general  relaxa- 
tion which  arc  known  to  follow  the  use  of  this  medicine  ;  while  others 
maintain  that  without  the  intervention  of  these  effects,  it  is  capable  of 
acting  primarily  and  directly  upon  the  vascular  system  so  as  to  lessen 
its  action.  The  latter  of  these  opinions  seems  to  be  best  supported  by 
fact  and  observation.  In  acute  cases  of  pneumonia  and  rheumatism 
very  large  quantities  of  this  article  can  be  given,  and  the  only  effect 
which  it  produces  is  to  diminish  vascular  action,  without  causing  other 
sensible  operation,  either  in  the  way  of  nausea,  vomiting,  purging,  or 
sweating.  Facts  of  this  kind  unquestionably  prove  that  tartar  emetic 
does  exert  a  primary  and  independent  action  as  a  sedative  on  the  circu- 
lation. Notwithstanding  this,  for  practical  purposes,  it  is  proper  to 
extend  our  views  of  the  operation  of  this  agent  somewhat  further,  and 
to  embrace  the  effects  of  nausea  as  occurring  frequently,  most  power- 
fully, in  producing  its  effect  upon  the  vascular  system. 

Circumstances  Modifying  these  Effects. — Age. — From  the  powerful 
effect  of  tartar  emetic  as  a  sedative,  it  is  an  agent  which  must  be  used 
with  great  caution  in  very  young  subjects.  Indeed  it  requires  to  be 
prescribed  Avith  the  same  precaution  as  bloodletting.  From  inattention  to 
this  fact  the  most  dangerous  and  even  fatal  consequences  have  resulted. 

Actual  Condition  of  the  System  as  to  Disease. — This  modifies  in  a 
remarkable  manner  the  effects  of  tartar  emetic.  In  health  it  acts  as  a 
sedative  on  the  circulation,  but  at  the  same  time  in  very  moderate 
doses  it  affects  the  stomach  with  nausea  and  vomiting,  and  sometimes 
free  purging  and  diaphoresis.  On  the  other  hand,  in  certain  affections 
characterized  by  high  inflammatory  action,  very  large  doses  may  be 
given  without  producing  any  other  effect  than  that  of  moderating  the 
action  of  the  heart  and  arteries.  This  is  particularly  illustrated  in 
pneumonia  and  rheumatism.  For  this  interesting  fact  we  are  indebted 
to  Rasori  and  the  Italian  physicians.  It  has  since  been  confirmed  by 
the  French,  English,  and  American  practitioners. 

Illustrations  of  the  tise  of  Tartar  Emetic  in  the  Treatment  of  Dis- 
eases.— Fever. — As  a  remedy  in  fever,  the  reputation  of  this  agent  is 
well  established.  Under  certain  restrictions,  with  due  precaution,  it 
may  be  used  in  almost  all  the  forms  of  febrile  disease.  The  mode  in 
which  it  proves  advantageous  is  obvious  from  its  effects.     It  operates 


312  MATERIA   HEDICA   AND   THERAPEUTICS. 

by  diminishing  the  action  of  the  heart  and  arteries,  equalizing  the  cir- 
culation, and  promoting  determination  to  the  surface,  and  in  these  ways 
proves  eminently  efficacious.  Acting  powerfully  on  the  system,  how- 
ever, its  indiscriminate  use  is  not  unattended  with  danger.  Where 
irritability-of  the  stomach  is  a  symptom  of  the  disease,  tartar  emetic 
almost  invariably  aggravates  it,  and  if  persisted  in  proves  exceedingly 
injurious.  Where  great  debility  is  present,  especially  in  the  advanced 
stages  of  fever,  this  article  acts  as  a  poison,  prostrating  the  patient,  and 
hurrying  him  out  of  existence.  Under  other  circumstances  tartar  eme- 
tic may  be  resorted  to  with  great  benefit  as  an  auxiliary,  and  sometimes 
as  a  substitute  for  the  lancet.  The  best  form  in  which  it  can  be  used  is 
that  of  solution,  in  doses  of  about  one-fourth  of  a  grain,  repeated  every 
second  hour. 

Inflammations. — As  a  general  remedy,  tartar  emetic  is  used  exten- 
sively in  almost  all  inflammatory  diseases  where  the  stomach  is  not  the 
seat  of  irritation,  and  with  the  same  intention  as  in  fever.  In  this 
country,  as  well  as  in  England,  the  practice  is  to  give  it  in  moderate 
doses.  Within  a  few  years  a  new  mode  of  administering  it  has  origi- 
nated with  the  Italian  physicians,  and  since  then  has  been  adopted  in 
other  countries.  The  peculiarity  of  the  practice  consists  in  the  large 
doses  which  are  given.  It  arose  with  the  founders  of  a  new  theory 
which  has  been  started  within  the  present  century,  and  which  is  called 
the  contra-stimulant  theory,  or  the  new  Italian  doctrine.  A  brief  notice 
of  this  doctrine  may  not  be  inappropriate,  as  explaining  the  rationale  of 
their  practice.  According  to  this  theory,  all  medicines  are  divided  into 
two  general  classes,  viz.  stimulants  and  contva-stimulants.  By  contra- 
stimulants  are  meant  those  agents  which  exert  a  positive  action  on  the 
living  fibre,  opposed  to  that  of  a  stimulant  action,  and  hence  their 
name.  In  other  words,  they  are  direct  sedatives.  Contra-stimulants 
are  supposed  to  have  the  power  of  subduing  excessive  excitement,  by  a 
specific  action  of  their  own,  independently  of  any  evacuations  being 
produced  from  the  system.  Tartar  emetic  is  one  of  the  substances 
placed  in  this  class,  and,  as  already  stated,  the  peculiarity  of  the  prac- 
tice founded  on  this  theory  consists  in  the  large  doses  in  which  not 
merely  this  article,  but  the  whole  class  of  contra-stimulants,  are  admi- 
nistered. It  is  only,  however,  in  a  certain  state  of  excitement  of  the 
system,  or  in  the  language  of  the  theory,  when  the  diathesis  of  stimu- 
lus exists,  that  these  doses  can  be  borne.  When  an  opposite  state  of 
the  system  is  present,  the  most  injurious,  if  not  fatal,  results  follow. 
When  a  patient  bears  these  large  doses  well,  and  without  producing  any 
evacuations  in  the  way  of  vomiting  or  purging,  it  is  called  a  tolerance  of 
the  remedy,  and  he  is  said  to  tolerate  it;  and  it  is  mainly  upon  the 
manner  in  which  the  patient  tolerates  the  remedy  that  the  propriety  of 
its  continuance  is  to  be  determined. 


BEDATJVKS.  313 

These  are  four  of  the  leading  points  of  this  theory,  and  it.  is  apoi 
principles  that  tartar  emetic  is  used  by  them  in  inflammation  .  The 
disease  in  which  it  has  been  most  extensively  used  i  pneumonia,  and 
the  following  will  serve  as  a  general  illustration  of  the  modi:  of  giving  it. 
If  the  attack  is  very  acute,  the  patient  is  first  to  be  bled  to  the  extent  of 
eighteen  or  twenty  ounces.  If  the  attack  is  mild,  this  may  be  omitted. 
He  is  then  put  upon  the  use  of  tartar  emetic,  in  doses  of  one  grain  dis- 
solved in  two  or  three  ounces  of  sweetened  water,  to  be  repeated  every 
two  hours.  Sometimes  the  first  dose  causes  vomiting  or  purgii 
After  this,  however,  the  patient  will  tolerate  the  remedy,  and  he  may  then 
go  on  taking  it  without  any  effect  of  this  kind  being  caused,  or  any  effect 
produced  on  the  skin.  Indeed,  when  tolerance  of  the  remedy  has  been 
once  established,  it  not  unfrequcntly  happens  that  patients  become  so 
costive  as  to  require  the  administration  of  injections.  In  ordinary  cases, 
after  giving  about  six  doses  of  the  medicine,  the  patient  may  be  left 
quiet  for  seven  or  eight  hours,  especially  if  lie  has  any  inclination  to 
sleep.  If,  however,  the  disease  be  violent,  and  the  oppression  at  the  chest 
be  great,  the  medicine  is  to  be  steadily  continued  until  amendment  takes 
place.  In  some  cases,  if  the  symptoms  be  urgent,  the  dose  is  increased 
to  a  grain  and  a  half,  or  to  two  grains.  When  the  disease  is  mild,  the 
patient  does  not  tolerate  the  medicine,  and  the  ordinary  effects  of  it  are 
produced.  When  violent,  on  the  contrary,  instead  of  these  effects,  it 
acts  more  like  an  opiate,  resembling  in  this  respect  the  operation  of  large 
doses  of  calomel  in  dysentery.  Generally,*  too,  the  sedative  effects  of 
the  remedy  are  most  decided  when  no  evacuations  take  place.  Among 
the  advantages  of  this  mode  of  treating  pneumonia,  it  is  urged  that  it 
does  not  leave  the  patient  so  liable  to  relapses,  that  the  subsequent 
debility  is  by  no  means  so  great  as  that  which  follows  the  ordinary  mode 
of  treatment  by  copious  and  repeated  bloodletting. 

Acute  Rheumatism  is  another  disease  in  which  large  doses  of  this 
remedy  have  also  been  tried,  and  with  great  success.  In  several  cases 
of  this  kind  I  have  prescribed  a  grain  of  tartar  emetic  every  hour,  and 
with  evident  success.  The  most  striking  cases,  however,  that  have  come 
to  my  knowledge  are  those  which  occurred  in  our  state  prison,  as 
reported  by  Drs.  Drake  and  Mauley.  In  one  case,  fifty-nine  grains 
of  tartar  emetic  were  given  in  five  days,  and  the  patient  perfectly 
cured  in  eight  days  from  the  commencement.  In  a  second  case,  three 
hundred  and  fifty-eight  grains  were  given  in  nine  days,  and  in  a  few 
days  after  the  patient  was  well  enough  to  leave  the  hospital  and  return  to 
his  work.     In  a  third  case,  two  hundred  and  forty-two  grains  were  taken 

*  According  to  Laennec,  the  greater  number  of  patients  vomit  once  or  twice, 
and  have  five  or  six  stools  the  first  day.  On  the  following  day  they  have  only 
slight  evacuations,  and  often  indeed  vomit  none  at  all. — N.  T.  Med.  and  Phys. 
Jour.,  No.  26. 


314  MATERIA   MEDICA   AND   THERAPEUTICS. 

in  seven  days,  and  the  patient  was  convalescent.  In  these  cases,  a  grain 
was  taken  every  ten  or  fifteen  minutes,  and  in  all  of  them,  with  the  excep- 
tion of  a  little  vomiting  after  the  first  few  days,  no  evacuations  were 
caused  of  any  kind,  and  nothing  occurred  during  the  administration  to 
cause  the  least  apprehension  from  any  ill  effects  which  might  have  been 
anticipated  from  such  large  and  repeated  doses. 

Without  recommending  this  practice  to  imitation,  it  must  be  conceded 
that  it  presents  exceedingly  interesting  facts,  in  relation  to  the  extent  to 
which  this  article  may  be  exhibited  in  certain  conditions  of  the  system. 
The  practice  is  certainly  gaining  ground  among  the  best  authorities,  both 
here  and  abroad.  [It  is  now  rarely  resorted  to,  indeed  tartar  emetic  is 
now  little  used  compared  with  what  it  was. — C.  R.  G.] 

Mode  of  Administration. — This  has  already  been  incidentally  noticed. 
The  first  dose  may  be  either  half  a  grain  or  a  grain  ;  if  this  causes  vomit- 
ing, a  few  drops  of  laudanum  may  be  added  to  the  second  dose  ;  as  soon  as 
tolerance  is  established,  the  dose  may  be  increased  to  a  grain,  or  perhaps 
a  grain  and  a  half,  and  they  may  be  repeated  every  two  or  three  hours, 
sometimes  indeed  every  hour,  and  continued  till  the  disease  gives  way. 

DIGITALIS. 

This  medicine  was  fully  treated  of  under  the  head  of  Diuretics,  when 
I  called  your  attention  to  a  somewhat  detailed  account  of  its  powers  as 
a  direct  sedative,  as  manifested  particularly  in  its  influence  on  the  pulse. 
The  diseases  in  which  we  could  avail  ourselves  of  this  power  were  also 
named.  I  will  not  go  here  into  any  details,  which  would  of  course  only 
be  a  repetition  of  what  has  been  said  already.  One  general  principle  in 
the  use  of  this  drug  is  sufficiently  important  to  justify  a  repetition.  I 
mean  that  digitalis  is  not  a  substitute  for  venesection  in  inflammatory 
affections.  It  is  often  a  useful,  sometimes  an  abused  essential  adjuvant, 
but  never  a  proper  substitute. 

HYDROCYANIC    ACID    (PrUSsic  Add). 

This  very  extraordinary  substance  is  procured  from  the  laurel,  peach,  ' 
cherry,  bitter  almond,  &c,  <fcc.  It  was  discovered  by  Scheele  in  1782. 
He  did  not,  however,  make  it  pure.  This  was  done  by  Gay  Lussac. 
Hydrocyanic  acid  is  a  compound  of  hydrogen  and  cyanogen.  It  is 
procured  in  two  very  different  states,  viz.  the  pure  anhydrous  acid, 
sometimes  called  the  acid  of  Gay  Lussac,  and  the  dilute,  or  medicinal, 
sometimes  called  Scheele's  acid. 

Pure  Acid. — This  is  made  by  decomposing  the  bicyanide  of  mercury 
with  sulphuretted  hydrogen,  and  then  distilling  off  the  acid  with  a  very 
gentle  heat,  receiving  the  product  in  a  cold  condenser. 


SEDATIVES.  815 

Properties. — Pure  prussic  acid  is  a  limpid,  colorless  fluid,  tasi 
to  be  at  first  cool,  but  soon  becoming  bot  and  acrid.     Odor  penetrating, 

and  usually  compared  1o  that  <>f  peach  blossoms.  This  is,  however,  not 
correct;  its  odor  is  very  different;  tbe  mistake  lias  arisen  from  con- 
founding tbe  odor  of  tbe  acid  with  that  of  volatile  oils  with  which  if.  is 
commonly  associated  in  plants.  It  is  exceedingly  volatile,  and  if  a  drop 
or  two  be  put  on  glass  or  paper,  it  instantly  congeals,  the  rapid  evapo. 
ration  of  one  part  of  tbe  acid  producing  cold  enough  to  freeze  the 
remainder. 

It  is  soluble  in  both  water  and  alcohol,  and  is  exceedingly  prone 
to  decomposition.  Magendic  says,  that  left  to  itself  in  well  slopped 
phials,  it  sometimes  decomposes  in  less  than  an  hour.  It  can  rarely  be 
kept  longer  than  a  fortnight.     It  is  not  used  in  medicine. 

Medicinal  Acid. — There  arc  a  great  number  of  formulas  for  the  pre- 
paration of  this  acid,  for  which  I  refer  you  to  the  pharmacopoeias. 

Properties. — Like  the  pure  acid,  this  is  colorless,  and  has  the  same 
penetrating  odor.  It  is  much  more  easily  preserved  than  the  pure, 
though  in  this  respect  there  is  a  great  difference  according  to  the  pro- 
cess by  which  it  is  prepared.  That  obtained  from  the  action  of  sulphu- 
retted hydrogen,  or  the  bicyanide  of  mercury,  being  most,  and  that 
from  the  action  of  sulphuric  acid  on  ferro-cyanide  of  potassium,  the 
least  prone  to  decomposition.*  It  should  be  kept  in  a  cold,  dark  place, 
in  well  stoppered  opaque  bottles. 

Effects  on  the  System. — Hydrocyanic  acid  appears  to  act  immediately 
and  directly  on  tbe  nervous  system,  impairing  the  general  sensibility 
and  irritability  of  the  body.  This  is  perfectly  obvious  when  animals 
are  destroyed  by  it;  and  the  same  general  effects,  differing  in  degree 
are  produced  by  it  when  given  in  medicinal  doses,  provided  they  be 
effective.  It  is,  therefore,  a  direct  sedative,  and  unlike  the  narcotics  in 
not  having  its  sedative  effects  preceded  by  any  excitement.  Whether 
it  acts  on  the  nerves  or  by  being  absorbed,  is  still  a  matter  of  dispute. 
The  predominating  opinion  is  that  it  is  so  absorbed.  Tbe  action,  how- 
ever induced,  is  on  the  nervous  system,  and  its  effect  is  to  impair 
energy  and  depress  vital  power.  It  does  not  directly  produce  sleep, 
and  its  powers  as  an  anodyne  are  very  trifling,  if  indeed  it  possesses  any.. 
On  the  Circulation. — Prussic  acid  lessens  the  force  of  action  of  the 
heart  and  arteries,  yet  it  does  not  possess  any  power  like  that  of  digi- 
talis in  making  the  pulse  slow. 

On  the  Stomach. — Its  action  is  directly  sedative  ;  it  impairs  sensi- 
bility and  controls  irritation  at  tbe  same  time  ;  it  rather  favors  secretion. 
On  the  Boivels. — It  is   rather  relaxing,  though  they  are  sometimes, 
costive  during  its  use.f 

*  Christison,  p.  116..  f  Elliotson,  p.  23. 

21 


316  MATERIA   MEDICA  AND  THERAPEUTICS. 

On  the  Kidneys. — Its  effects  are  not  marked,  though  by  some  it  is 
thought  to  increase  the  flow  of  urine. 

Such  are  the  effects  of  hydrocyanic  acid  on  the  system,  and  from 
them  are  deduced  its  practical  application  to  the  cure  of  disease. 

Affections  of  the  Stomach. — Prussic  acid  has  been  a  good  deal  used 
iu  the  diseases  of  this  organ.  In  controlling  vomiting  it  is  second  in 
power  to  no  known  agent.  In  gastrodynia  and  pyrosis  it  has  been 
much  used,  and  often  with  excellent  effects. 

In  Pulmonary  Affections. — In  this  class  of  diseases  the  acid  had 
much  more  reputation  than  it  has  preserved.  In  phthisis  it  was  once 
proclaimed  as  almost  a  specific.  But  experience  has  abundantly  proved 
that  except  as  a  palliative  it  is  of  no  sort  of  use  in  the  disease.  As  a 
palliative,  however,  it  is  often  of  very  great  value ;  it  relieves  cough, 
checks  night  sweats,  and  by  relieving  irritation  often  promotes  sleep. 
In  short,  it  smoothes  the  pathway  to  the  grave,  and  perhaps  delays  the 
progress  of  the  patient,  it  can  do  no  more. 

In  Hooping  Cough. — Here  great  advantage  may  be  derived  from  the 
acid,  if  it  be  used  after  suitable  depletion  and  evacuation.  It  mitigates 
and  speedily  arrests  the  spasmodic  cough,  and  accelerates  the  cure.  Dr- 
Thomson  says,  "  in  hooping  cough  I  regard  it  as  the  sheet  anchor  of  the 
practitioner."  After  an  emetic  and  a  brisk  purge  he  gives  nothing  but 
the  acid,  gradually  increasing  the  dose. 

In  Chronic  Catarrh  it  may  be  used  to  lull  the  cough,  and  diminish 
the  irritability  of  the  bronchial  mucous  membrane. 

In  the  Acute  Inflammatory  Affections  of  the  Chest. — Though  highly 
commended  by  Brera,  it  cannot  be  relied  on.  As  a  substitute  for  bleed- 
ing, when  the  inflammatory  symptoms  are  subdued  and  great  irritability 
remains  behind,  it  will  come  in  very  well. 

In  Dyspepsia. — If  this  seem  to  depend  rather  on  an  irritable  state  of 
the  stomach  than  on  inflammation,  whether  acute  or  chronic ;  if  the 
food  causes  distress,  and  digestion  is  attended  with  pain,  hydrocyanic 
acid  will  very  often  afford  relief,  and  sometimes  very  promptly.  In 
heart  disease,  though  it  is  lauded  by  some,  its  powers  are  probably  not 
great.  Where  irritable  action  of  the  heart  and  arteries  depends,  as  in 
the  absence  of  organic  diseases  it  often  does,  on  diseases  of  the  stomach, 
the  acid,  by  relieving  the  latter,  may  remove  the  former  symptoms ; 
where  organic  disease  is  present,  it  can  do  no  good,  and  may  do 
harm. 

Mode  of  Administration,  Dose,  &c. — Prussic  acid  is  best  taken  in 
simple  sweetened  water;  as  it  is  very  apt  to  rise  to  the  surface,  the 
patient  should  be  warned  to  shake  the  phial  well  before  taking  the 
medicine.  As  a  matter  of  prudence,  only  a  small  quantity  should  be 
left  in  the  possession  of  the  patient  at  once ;  and  when  a  new  parcel  is 
obtained,  the  dose  should  always  be  small  till  it  is  tried,  as  the  acid 


SEDATIVES.  .',17 

varies  so  exceedingly  in  si  rength.  I /iff  Ims  hrm  lost  by  neglect  of  tl 
simple  precaution!  It  is  best  to  begin  with  a  small  dose,  Bay  one  or 
two  drops  every  three  or  four  hours,  increasing  the  dose  daily  by  one 
drop,  till  the  proper  one  is  ascertained,  by  the  appearance  of  omi 
physiological  effect — the  most  common  of  these  is  a  dryness  or  stiffness 
of  the  posterior  fauces,  with  sluggish  movement-  of  the  tongue.  The 
operation  of  this  acid  should  be  most  carefully  watched. 

External  Application.- — A  lotion  made  by  mixing  ten  or  fifteen  drops 
of  the  medicinal  acid  with  an  ounce  of  water,  is  used  by  some  to  al 
troublesome  itching  and  irritation,  in  some  of  the  cutaneous   disc; 
It  has  also  been  used  with  advantage  to  irritable  ulcers. 


TOBACCO. 

This  is  the  Nicotiana  tabacum.  It  is  a  native  of  America,  and  its  use 
as  an  article  of  luxury  was  known  to  the  natives  long  before  the  disco- 
very of  this  continent.  Baron  Humboldt  states  that  it  had  been  culti- 
vated from  time  immemorial  by  the  people  of  the  Oronoco,  and  was 
smoked  all  over  America  at  the  time  of  the  Spanish  conquest.  Accord- 
ing to  the  same  authority,  the  plant  was  "  first  discovered  in  the  Mexi- 
can province  of  Yucatan  in  1520,  and  it  was  there  called  Petum"  From 
thenee  it  was  transported  to  the  West  Indies  and  North  America.  Its 
introduction  into  Europe  took  place  in  the  year  1560,  when  Jean  Nicot, 
at  that  time  ambassador  to  the  court  of  Portugal  from  Francis  II.,  of 
France,  purchased  some  of  the  seeds  from  a  Dutchman,  who  had  just 
brought  them  over  to  Lisbon  from  America.  By  Nicot  the  seeds  were 
sent  to  France,  and  from  these  the  plant  was  successfully  raised  in  that 
country.  From  the  agency  which  Nicot  thus  had  in  introducing  the 
tobacco  into  France,  it  received,  after  him,  the  name  of  JVicotiana,  the 
specific  appellation,  Tabacum,  according  to  Humboldt,  being  "  taken 
from  the  word  tabac,  the  name  of  an  instrument  used  by  the  natives  of 
America,  in  the  preparation  of  the  herb ;"  or,  according  to  others,  from 
the  island  of  Tobago,  from  which,  by  some,  it  is  said  to  have  been  first 
brought  to  Europe.  Into  England  it  was  introduced  by  Sir  Francis 
Drake.  It  owed,  however,  all  its  popularity  in  that  country  to  the  cele- 
brated. Sir  Walter  Raleigh,  whose  eulogium  of  it  rendered  it  fashionable, 
and  brought  it  into  extensive  use. 

The  history  of  tobacco  forms  a  curious  chapter  in  the  annals  of  our 
race.  Next  to  intoxicating  liquor,  there  is  no  substance  which  has  gain- 
ed such  an  ascendency  over  hnman  taste  and  appetite  as  tobacco.  There 
is  no  nation  on  the  face  of  the  globe,  civilized  or  savage,  where  it  has 
not  found  its  way.  Europe,  Asia,  Africa,  and  America,  are  all  familiar 
with  it.     There  is  no  condition  of  society  in  which  it  is  not  a  favored 


318  MATERIA  MEDICA   AND   THERAPEUTICS. 

guest.  You  find  it  in  the  palace  and  the  poor-house — in  the  stately 
mansion  and  the  humble  cottage — in  the  work-shop  and  the  billiard- 
room.  The  lonely  exile  solaces  his  weary  hours  with  it — the  joyous 
freeman  exults  in  its  influence.  Philosophy  muses  under  its  power — 
poetry  is  inspired  and  hardy  labor  cheered  by  tobacco.  "Wherever  man 
is  found,  its  influence  is  felt  and  acknowledged.  The  citizen  whiffs  his 
perfumed  cigar — the  poor  man  smokes  his  sooty  pipe — the  sailor  chews 
his  delicious  quid — the  matron  rejoices  in  her  pinch  of  snuff.  On  the 
mountain  top  and  in  the  lonely  valley — on  the  land  and  on  the  broad 
expanse  of  ocean — in  the  dark  mines  of  Pennsylvania  and  in  the  glitter- 
ing halls  of  Paris — on  the  rugged  hills  of  Switzerland  and  in  the  gold- 
bearing  valleys  of  California — amid  the  snows  of  the  North  and  under 
the  burning  sun  of  the  tropics — in  battle  and  in  peace — in  storm  and  in 
calm — in  wealth  and  in  poverty — in  health  and  in  sickness — the  king 
and  the  subject — the  master  and  the  slave — youth,  manhood,  and  old 
age — all,  all  bow  to  the  magic  power  of  tobacco. 

What  is  still  further  curious  in  relation  to  this  plant  is,  that  it  gained 
this  universal  ascendency  notwithstanding  the  most  powerful  opposition. 
By  the  wise  it  was  reprobated,  by  the  powerful  it  was  denounced.  Even 
popes  and  monarchs  did  not  consider  it  beneath  their  dignity  to  engage 
in  the  general  crusade  against  it.  To  give  you  some  idea  of  the  in- 
dignation excited  against  this  article,  I  will  quote  the  language  of  some 
of  those  who  wrote  against  it.  Old  Burton,  in  his  "  Anatomy  of  Me- 
lancholy," of  which  the  celebrated  moralist,  Dr.  Johnson,  says,  it 
was  the  only  book  that  ever  took  him  out  of  bed  sooner  than  he  wish- 
ed to  rise,  gives  the  following  anathema  against  tobacco.  "  Tobacco, 
divine,  rare,  super-excellent  tobacco,  which  goes  far  beyond  all  their 
panaceas,  potable  gold,  and  philosopher's  stones,  a  sovereign  remedy  to 
all  diseases.  A  good  vomit,  I  confesse,  a  vertuous  herb,  if  it  be  well 
qualified,  opportunely  taken,  and  medicinally  used ;  but  as  it  is  com- 
monly abused  by  men,  which  take  it  as  tinkers  do  ale,  'tis  a  plague, 
a  mischief,  a  violent  purger  of  goods,  lands,  health :  hellish,  devilish  and 
damned  tobacco,  the  ruine  and  overthrow  of  body  and  soul." — Vol.  ii. 
p.  109. 

Another  writer,  Joshua  Sylvester,  wrote  a  poem  on  tobacco,  which  he 
dedicated  to  Villiers,  Duke  of  Buckingham.  This  book  was  entitled, 
"  Tobacco  battered,  and  the  pipes  shattered  (about  their  ears  who  idly 
idolize  so  base  and  barbarous  a  weed  ;  or  at  least-wise  overlove  so  loath- 
some a  vanity),  by  a  volley  of  hot  shot  from  Mount  Helicon." — American 
Quarterly,  vol.  ix.  p.  14.  In  this  work  the  author  questions  whether  the 
devil  had  done  more  harm  in  latter  ages  by  means  of  fire  and  smoke, 
through  the  invention  of  guns  or  tobacco  pipes,  and  he  conjectures  "that 
Satan  introduced  the  fashion  as  a  preparatory  course  of  smoking  for 
those  who  were  to  be  matriculated  in  his  own  college." 


SEDATIVES.  319 

King  James  I.  of  England  wrote  a  formal  treatise  againsl  it,  entitled, 
a  "Counter  Blast  to  Tobacco,"  in  which  In:  say;-,  the  use  ''I'  it  " 
toiii  loathsome  to  the  eye,  hateful  to  the  nose,  harmful  to  flic  brain,  dan- 
gerous to  the  lungs;  and  in  the  black,  stinking  fume  thereof,  nea 
resembling  the  horrible  Stygian  smoke  of  the  pit  that  is  bottomle  ." 
He  states  also  that  "if  lie  should  invite  the  devil  to  dine  with  him,  he 
would  among  other  things  give  him  a  pipe  of  tobacco,  a-  particularly 
agreeable  to  him,  to  help  digestion." 

The  Popes  Urban  and  Innocent  XII.  both  published  edicts  of  excom- 
munication against  all  those  who  took  cither  snuff"  or  tobacco.  To  re- 
strain the  cultivation  of  tobacco  in  Virginia,  and  to  prevent  its  exporta- 
tion into  England,  several  arbitrary  measures  were  attempted  during  the 
reign  of  James  I.  By  some  of  the  Swiss  Cantons,  smoking  was  consi- 
dered a  crime  second  only  to  adultery;  and  to  cap  the  climax  of  sevei 
against  this  poor  plant,  Amurath  IV.  made  the  use  of  tobacco  a  crime 
punishable  with  death.  Still  the  fragrant  weed  flourished,  and  loyal  sub- 
jects and  devout  Christians,  sturdy  republicans  and  slavish  Asiatics,  all, 
all  resist  the  law  and  yield  to  the  influence  of  Tobacco. 

Tobacco  is  an  annual  plant,  growing  about  four  feet  high.  It  is 
planted  in  the  spring,  and  flowers  in  July  and  August.  At  one  time  it 
was  raised  to  a  considerable  extent  in  some  parts  of  England.  At  present 
that  country,  as  well  as  the  greatest  part  of  Europe,  is  chiefly  supplied 
from  the  State  of  Virginia.  It  is  cultivated  also  in  every  part  of  the 
East  Indies  and  in  the  Eastern  Islands.  Of  the  species  of  tobacco  known 
by  the  name  of  Virginia  tobacco  there  are  two  varieties — a  broad  and  a 
narrow  leaved  sort.  They  do  not  differ,  however,  in  their  properties. 
In  cultivating  the  plant  it  is  not  allowed  to  attain  its  full  height,  but  is 
topped  whenever  a  certain  number  of  leaves  are  thrown  out.  This  is 
done  to  promote  the  development  of  the  leaves,  by  preventing  the  for. 
rnation  of  the  flowers  and  seeds.  It  is  cut  down  in  the  month  of  Au- 
gust, and  the  plants  hung  up  in  pairs  under  sheds  to  dry,  after  which 
the  leaves  are  separated  from  the  stem,  bonnd  up  in  bundles,  and  packed 
in  the  hogsheads  in  which  they  are  exported.  The  parts  used  are  the 
leaves,  which  are  about  two  feet  long  and  four  inches  broad  ;  when  fresh 
they  are  of  a  pale  green  color,  and  when  carefully  dried  of  a  lively  yel- 
low. Their  smell  is  strong,  disagreeable,  and  narcotic;  their  taste  bitter 
and  acrid. 

The  active  principles  of  tobacco  are  a  peculiar  oil-like  alkaloid  called 
nicotina,  and  a  camphoraceous  volatile  oil  termed  nkotianin.  It  is  the 
first  of  these  upon  which  the  active  power  of  tobacco  depends.  In 
10,000  parts  of  the  leaf,  6  parts  of  nicotina  were  obtained  and  1  of 
nicotianin.  The  empxjrcurnatic  oil  of  tobacco,  which,  as  found  in  the 
pipe  of  the  smoker,  is  an  active  poison,  appears  to  be  nicotina  attached 
to  a  true  volatile  oil.     [Christison.] 


320  MATERIA    MEDIC  A   AND   THERAPEUTICS. 

Nicotina  is  so  active  a  poison  that  half  a  grain  has  been  known  to  kill 
a  dog.     [Christison.] 

Tobacco  leaves  yield  their  virtues  both  in  water  and  alcohol — more 
so  in  the  latter. 

Effects. — These  differ  according  to  the  mode  of  use  and  the  object  had 
in  view  in  its  use.  Its  effects  are  local  and  general.  The  first  are 
stimulant.  If  applied  to  the  nostrils  in  the  form-  of  snuff,  it  causes 
sneezing  and  increased  secretion  from  the  nose.  Taken  into  the  mouth 
and  chewed,  or  applied  in  the  form  of  smoke,  it  stimulates  the  salivary 
glands,  and  causes  a  flow  of  saliva. 

Its  general  effects  on  the  system  are  sedative  and  relaxing. 

In  large  doses  it  is  a  virulent  poison,  acting  principally  on  the  brain 
and  heart.  It  impairs  the  action  of  the  heart,  causing  a  sense  of  flutter- 
ing— excessive  faintness — copious  perspiration — sense  of  alarm — sickness 
and  vomiting — coldness  of  skin — feebleness  of  pulse — convulsions  and 
death.  When  used  in  medicinal  doses,  we  give  it  simply  for  the  relax- 
ing effects  which  it  produces,  and  particularly  on  the  muscular  tissue. 
It  produces  sickness — sometimes  vomiting — relaxation  of  the  bowels — 
lessens  the  force  and  frequency  of  the  pulse — promotes  the  flow  of  urine, 
and  causes  general  relaxation. 

With  regard  to  the  effects  of  tobacco-,  it  is  important  to  recollect  that 
they  are  modified  by  a  number  of  circumstances. 

1.  The  quality  of  the  tobacco.  It  is  well  known  that  the  strength  of 
tobacco  varies  very  much,  according  to  the  climate,  etc.,  in  which  it  is 
reared.  In  warm  latitudes-  it  is  mild  ;  in  cold  regions  pungent  and 
acrid.  Bengal  tobacco,  I  believe,  is  the  weakest ;  next  to  this  is  the 
West  Indian  tobacco.  Northern  tobacco  is  the  strongest.  According 
to  experiments,  in  1000  parts  of  tobacco  the  following  proportions  of 
nicotina  were  found  in  different  kinds  of  this  article  :  8.64  in  Havana 
tobacco,  10.00  in  Virginia,,  and  11.28  in  some  specimens  grown  in 
France.  (See  Christison's  Dis.)  The  soil,  too,  makes  a  difference  in 
its  quality.  In  a  virgin  soil  it  is  mild,  while  in  one  richly  manured  it 
is  very  rank.     (Rogers,  58.) 

2.  The  habits  of  the  person  also  modify  very  much  the  effect  of  this 
article.  Thus  you  all  know,  that  if  a  person  has  been  accustomed  to  the 
use  of  tobacco,  he  can  bear  quantities  of  it  which  under  other  circum- 
stances would  produce  very  unpleasant  effects.  From  the  mere  force  of 
habit,  some  persons  can  remain  under  the  influence  of  tobacco  in  some 
shape  or  other  from  morning  till  night. 

3.  The  age,  sex,  peculiar  constitution,  etc.,  also  modify  the  effects.  To 
children  under  four  or  five  years  it  ought  never  to  be  given ;  it  may 
prove  fatal  to  them.  Females  are  much  more  severely  affected  by  it 
than  males.  Persons  of  delicate  and  nervous  constitutions  too,  have 
their  systems  much  more  affected  by  it  than  the  robust  and  strong. 


SEDATIVES.  .321 

A  great  difference  is  observed   according   as    the  stomach    is    full  or 
empty. 

Tobacco  acts  upon  tlic  system  in  whatever  way  it,  is  applied,  whether 
by  the  month,  rectum,  lungs,  skin,  etc. 

Mode  of  Administration. — As  a  medicine  it  is  little  used  except  by 
the  anus  ;  as  a  luxury,  it  is  used  by  the  mouth. 

There  are  two  forms  in  which  this  article  is  used  as  an  injection — 
smoke  and  infusion.  The  latter  is  the  mode  generally  resorted  to,  and 
can  be  better  regulated  than  the  smoke.  As  tobacco  is  so  powerful  a 
poison,  great  care  should  be  taken  in  not  giving  the  injection  too  strong. 
One  drachm  in  this  way  has  proved  fatal,  and  sometimes  even  half  a 
drachm  has  produced  the  same  effect.  As  a  general  rule,  therefore,  the 
best  plan  is  never  to  exceed  fifteen  to  twenty  grains,  infused  upon  a  pint 
of  boiling  water,  and  draining.  This  will  commonly  produce  sufficient 
of  the  relaxing  effects  without  any  of  the  poisonous  ones.  "If  the  in- 
jection does  not  come  away  in  five  minutes,  it  should  be  assisted  by 
throwing  up  a  large  quantity  of  tepid  water ;  and  if  its  sedation  be  too 
great  or  lasting,  such  stimulants  as  ammonia  and  brandy  ought  to  be 
administered."  (Christison.)  Sometimes  it  is  used  as  a  local  applica- 
tion either  in  the  form  of  cerate  or  a  plaster  made  of  snuff. 

As  a  luxury,  tobacco,  as  you  know,  is  used  in  almost  every  form. 
Pulverized  and  manufactured  into  snuff,  we  have  every  variety,  from  the 
acrid  Scotch  to  the  more  delicate  rappee  ;  of  cigars  we  have  all  sorts, 
and  shapes,  and  sizes ;  and  of  tobaccos  time  would  fail  me  to  tell  of  the 
short  cut  and  the  long  cut,  the  coarse  cut  and  the  fine  cut,  ladies'  twist 
and  Virginia  twist,  pig  tail,  negro  head,  and  the  thousand  other  forms 
into  which  human  ingenuity  has  tortured  this  article. 

Of  the  Uses  of  Tobacco. — If  tobacco  in  medicinal  doses  be  the  active 
article  which  it  certainly  is,  it  ought  to  be  used  with  great  caution.  Like 
all  articles  of  this  kind,  it  ought  to  be  reserved  for  such  cases  and  emer- 
gencies as  cannot  be  met  by  milder  means,  and  such  is  the  general 
judgment  of  the  profession.  There  are  cases,  however,  in  which  it  has 
been  used  with  advantage,  where  we  require  the  profound  relaxation 
which  this  substance  produces.  The  class  of  cases  in  which  it  has  been 
used  with  advantage  are  those  in  which  muscular  and  fibrous  tissue 
requires  to  be  relaxed.  Among  these  are  tetanus,  and  retention  of  urine 
arising  from  spasmodic  stricture  of  the  urethra.  Several  cases  are 
related  by  Mr.  Earle,  in  which  this  succeeded  where  instruments  could 
not  be  introduced,  and  where  venesection  and  other  remedies  had  failed. 
In  ten  or  fifteen  minutes  after  the  tobacco  enema,  urine  flowed.  It  is 
also  used  by  the  surgeons  in  cases  of  incarcerated  hernia.  Dr.  Ainslee 
says  the  native  practitioners  in  the  East  Indies  are  in  the  habit  of  apply- 
ing the  leaves  warmed  to  the  orifice  of  the  anus  in  obstinate  constipa- 
tion, and  with  uniform  success  in  these  cases.  Applied  in  this  way  it 
generally  vomits. 


322  MATERIA   MEDICA   AND   THERAPEUTICS. 

Formerly  tobacco  was  used  internally  in  dropsy  as  a  diuretic.  It  is 
not  used  at  present. 

Externally  applied  it  has  been  used  to  promote  absorption  in  swelled 
breasts  or  buboe^.  The  snuff  plaster  is  still  occasionally  used  in  croup, 
but  it  should  be  carefully  watched,  as  the  constitutional  effects  may  be 
dangerous. 

With  regard  to  the  use  of  tobacco  as  an  ordinary  luxury,  your  opi- 
nion will  be  frequently  asked  when  you  get  into  practice.  On  this  sub- 
ject I  need  not  tell  you  there  is  a  great  difference  of  opinion.  By  some 
it  is  denounced  as  always  injurious.  By  others  it  is  considered  not 
merely  innocent,  but  even  salutary.  As  is  generally  the  case,  truth  lies 
in  the  middle.  If  the  use  of  tobacco  were  attended  with  the  conse- 
quences attributed  to  it  by  some,  in  what  a  miserable  condition  would 
the  poor  human  race  be,  wasting  under  a  slow  and  deadly  poison  which 
they  are  taking  in  daily,  and  yet,  lamentable  to  say,  totally  unconscious 
of  it. 

A  good  cause  is  never  promoted  by  attempts  to  mystify  the  truth, 
and  common  observation  settles  the  question  that  the  moderate  and 
daily  use  of  tobacco  does  not  always  prove  injurious.  This  is  as  a  gene- 
ral rule  ;  constitutions,  however,  are  seriously  and  insidiously  injured  by 
its  moderate  use,  while  to  all  its  excessive  use  is  unquestionably  detri- 
mental. 

As  the  result  of  a  good  deal  of  observation,  the  conclusions  to  which 
I  have  come  in  relation  to  the  use  of  tobacco  are  the  following : 

1.  It  is  not  necessary  for_  man.  The  inhabitants  of  the  old  world 
before  they  were  acquainted  with  this  article,  enjoyed  as  vigorous  health 
and  lived  as  long  as  we  do  in  the  present  day. 

2.  To  some  persons,  and  in  certain  conditions,  it  may  prove  salutary. 
I  know  a  gentleman  who  consulted  me  about  twenty  years  ago.  He  was 
plethoric,  and  was  troubled  with  inordinate  action  of  the  arterial  system, 
but  otherwise  well.  I  advised  him  to  smoke  moderate^,  and  he  is  still 
living,  and  thinks  he  owes  his  life  to  the  prescription. 

3.  To  many  it  is  positively  deleterious.  I  am  convinced  that  a  large 
proportion  of  the  dysjiepsias  which  are  prevalent  are  owing,  as  their  re- 
mote cause,  to  the  use  of  tobacco.  It  impairs  the  tone  of  the  digestive 
organs,  and  renders  the  whole  system  nervous.  To  those  predisposed 
to  consumption,  it  is  manifestly  bad.  This  is  a  disease  of  debility,  and 
everything  that  debilitates  the  system  must  be  injurious. 

4.  To  young  people  tobacco  generally  is  injurious,  and  for  a  very 
obvious  reason.  Until  a  certain  age,  the  human  system  does  not.  receive 
its  full  growth  and  development.  If  a  boy  at  the  age  of  14  or  15  begins 
to  use  tobacco  and  spit  freely,  it  must  retard  his  growth,  and  perhaps 
lay  the  foundation  of  serious  disease. 

5.  It  is  idle  for  the  moralist  or  the  physician  to  engage  in  an  indis- 


SEDATIVES.  328 

criminate  crusade  against  the  use  of  tobacco.  Tlie  one  maj  exhorl  and 
the  other  may  command,  but  it  will  all  be  of  no  avail,  [t  baa  become 
an  artificial  want,  and  people  arc  not  to  be  coaxed  or  blustered  out  of  it. 
The  physician,  however,  can  do  a  great  deal  in  preventing  the  abi 
it,  and  this  he  ought  always  to  attempt.  In  every  patient  laboring 
under  chronic  disease  this  ought  to  he  made  the  special  inquiry  and 
direction. 

With  regard  to  the  comparative  effects  of  chewing  and  smoking,  I  go 
decidedly  for  the  latter.  If  a  man  smokes  as  a  gentleman,  he  can  only 
do  it  at  certain  seasons  and  in  certain  situations.  There  must  be  an  in- 
termission. But  to  chewing  there  is  no  limit  or  check.  A  man  who 
chews  may  put  a  quid  in  his  mouth  when  he  wakes  in  the  morning  and 
keep  it  there  till  he  goes  to  bed  at  night,  aye,  and  all  night  too.  In 
this  way  he  is  constantly  kept  under  its  influence.  [Much  might  he 
said  for  my  favorite  pinch  of  snuff,  but  I  forbear. — Ed.] 


COLCHICUM    AUTUMNALE. 

This  is  a  small,  perennial,  bulbous  plant,  growing  native  in  the  tem- 
perate regions  of  Europe,  where  it  is  found  wild  in  moist  meadows.  The 
•common  name  is  the  meadow  saffron.  In  this  country  its  cultivation  has 
been  attempted,  but  without  much  success.  The  parts  used  in  medicine 
are  the  bulbs  and  the  seeds. 

There  are  certain  peculiarities  attending  the  growth  of  this  plant  which 
are  important  to  be  recollected,  as  they  throw  light  upon  the  effects  of 
it  as  a  medicine.  At  the  time  of  flowering  in  the  autumn,  a  new  bulb 
begins  to  form  on  the  side  of  the  old  one,  which  partly  embraces  it.  As 
the  new  one  increases,  the  old  bulb  gradually  wastes  away  until  the 
following  May  or  June,  when  the  one  is  perfected  and  the  other  entirely 
decayed.  It  is  evident  from  this  that  the  strength  of  the  bulb  must 
vary  greatly  at  different  seasons  of  the  year.  The  proper  period  for 
gathering  it  in  England  is  in  June  and  August.  If  taken  early  in 
the  spring  the  bulb  is  too  young,  and  if  taken  late  in  the  autumn  the 
old  bulb  is  exhausted  by  the  new  offset. 

The  mature  bulb  is  of  an  ovoid  shape,  and  about  the  size  of  a  walnut. 
When  fresh  it  yields,  on  cutting,  an  acrid,  milky  juice.  When  dried  it 
is  of  a  brownish  color,  with  a  deep  groove  running  through  it,  and  has 
no  smell,  but  an  acrid,  bitter  taste.  Mr.  Donovan  thinks  that  drying 
the  bulb  interferes  with  its  powers,  and  Dr.  A.  T.  Thomson  says  the 
acrimony  on  which  its  virtues  depend  is  partially  dissipated  by  drying 
and  long  keeping,  and  totally  destroyed  by  a  heat  over  212°.  Sir  E. 
Home  recommends  the  wine  made  of  the  recent  bulbs  cut  up  while 


324  MATERIA  MEDICA   AND   THERAPEUTICS. 

fresh,  and  immediately  thrown  into  wine.  As  soon  as  dug  up,  it  should 
be  cut  into  slices  and  dried,  otherwise  it  begins  to  vegetate. 

The  seeds  are  small,  and  when  ripe  of  a  dark  brown  color.  They 
should  be  gathered  when  fully  ripe  and  then  dried.  Their  active  pro- 
perties reside  in  the  husk.  They  should  therefore  not  be  bruised  when 
used. 

All  the  virtues  of  the  bulb  are  extracted  by  wine  and  vinegar. 

Effects. — In  its  effects  on  the  system  colchicum  is  peculiar.  It  acts 
as  a  sedative  to  the  nervous  and  vascular  systems,  and  at  the  same  time 
promotes  secretion.  If  given  in  moderate  doses,  it  lowers  the  pulse  and 
alleviates  pain  without  producing  any  other  manifest  effect.  If  given 
in  larger  closes  it  causes  nausea,  vomiting,  purging,  accompanied  with 
great  prostration  and  depression  of  the  pulse.  Although  placed  by  some 
writers  along  with  diuretics,  its  action  on  the  kidneys  is  very  uncertain. 
According  to  observations  of  Chelius,  a  curious  effect  is  produced  by  it 
on  the  character  of  the  urine,  and  that  is  to  increase  the  quantity  of  uric 
acid.  Thus,  it  is  stated  that  he  found  on  the  fourth  day  after  using 
colchicum,  the  quantity  of  uric  acid  excreted  was  0069  parts ;  after  four 
days  using  it  was  0*076  ;  eight  days,  0'091  ;  twelve  days,  0'112,  nearly 
doubling  the  quantity  in  twelve  days. 

In  excessive  doses  it  produces  all  the  effects  of  a  narcotico-acrid  poi- 
son ;  where  it  proves  fatal  there  is  generally  found  inflammation  of  the 
stomach  and  bowels. 

In  relation  to  the  use  of  this  article  as  a  medicine,  there  are  two  cir- 
cumstances worthy  of  recollection.  The  first  of  these  is  the  uncertainty 
which  attends  its  operation.  This,  as  has  frequently  been  remarked,  is 
owing  to  the  difference  in  the  strength  of  the  bulb,  from  causes  already 
noticed. 

Another  circumstance  is  that  it  sometimes  acts  very  unexpectedly, 
with  great  activity  on  the  system,  and  is  attended  with  unpleasant,  and 
even  dangerous  consequences.  Dr.  Armstrong  accordingly  lays  it  down 
as  a  rule,  to  discontinue  the  use  of  it  as  soon  as  it  brings  on  sickness  or 
purging.  In  some  cases,  too,  it  produces  profound  languor  and  lassitude, 
without  either  sickness  or  purging.  This,  too,  indicates  that  its  use 
ought  to  be  stopped,  for  the  patient  may  sink  in  this  state  of  collapse. 
Armstrong  alludes  to  a  case  where  death  resulted  in  consequence  of  con- 
tinuing the  use  of  it  after  the  purging  and  sickness  had  commenced. 
(Lectures,  p.  354.)'*  In  all  cases,  therefore,  when  a  patient  is  under  the 
use  of  this  article  he  ought  to  be  carefully  watched. 

Forms  of  Administration.  Substance. — The  powder  of  the  bulb  in 
doses  of  from  grs.  iij.  to  grs.  v.  repeated  about  three  times  a  day.  Dr. 
Armstrong  recommends  that  in  this  form  it  should  never  be  used  except 

*  See  also  Beardsley,  p.  118. 


SEDATIVES.  325 

in  combination  with  an  aperient.  If  sickness  should  occur,  so  much  of 
the  powder  may  be  absorbed  as  to  prove  dangerous,  lie  states  that  be 
saw  one  patient's  life  nearly  sacrificed  by  inattention  to  bis  circum- 
stance. 

Acetum  Colchici. — The  vinegar  of  colchicum  is  prepared  by  mace- 
rating two  ounces  of  the  dried  bnlb  sliced  in  two  pints  of  vinegar,  and 
then  adding  a  fluid  ounce  of  alcohol  to  preserve  the  preparation  from 
decomposition.     Dose  from  half  a  drachm  to  a  drachm. 

Tincture  and  Wine. — From  the  variable  strength  of  the  bulb  the 
only  way  is  to  prepare  a  saturated  tincture  or  wine.  Of  these  the  dosi 
is  from  half  a  drachm  to  a  drachm  repeated  three  or  four  times  a  day. 

As  the  bulb  is  uncertain  in  its  strength,  the  seeds  have  been  lately 
used  as  a  substitute.  A  tincture  or  wine  is  prepared  by  macerating  an 
ounce  of  the  seeds  in  a  pint  of  Teneriffe  wine.  As  the  active  properties 
reside  in  the  husk,  the  seeds  should  not  be  bruised.  .  The  dose  is  from 
half  to  one  drachm. 

With  regard  to  all  the  preparations  of  colchicum,  Dr.  Armstrong 
remarks,  that  by  long  keeping  or  exposure  to  the  light  they  become 
more  or  less  impaired  in  their  virtues.  Hence  he  advises  them  to  be 
kept  in  a  dark  place,  wrapped  in  paper,  or  in  opaque  vessels.  (Lec- 
tures, p.  353.) 

Colchicum  is  not  a  remedy  used  in  a  great  number  of  diseases.  It  is 
particularly  celebrated  in  the  treatment  of  gout  and  rheumatism,  and  in 
these  it  sometimes  proves  exceedingly  valuable.  It  is  supposed  to  be 
the  active  ingredient  in  the  celebrated  remedy  for  the  gout,  the  Eau 
Medicinale  d'Husson.  In  gout  it  sometimes  produces  relief  without 
any  sensible  evacuation,  acting  simply  as  a  sedative.  Generally,  how- 
ever, you  will  find  that  the  patient  is  not  relieved  until  it  acts  on  the 
bowels.  In  acute  rheumatism,  it  is  advisable  to  bleed  before  prescribing 
the  colchicum,  although  by  some  it  is  considered  to  be  a  substitute  for 
the  lancet.  You  will  not  find,  however,  this  to  be-  the  case  any  more 
than  with  digitalis.  Both  are  good  adjuvants  to  bloodletting,  but  not 
substitutes  for  it. 

Colchicum  has  also  been  used,  and  with  some  success,  in  [dropsy  and 
in]  inflammatory  affections  of  the  chest. 


ACONITUM    NAPELLUS. 

This  is  commonly  known  by  the  name  of  monkshood  or  wolf's-banc. 
It  is  a  pereunial  herbacous  plant,  growing  from  two  to  six  feet  in 
height,  and  found  abundantly  on  the  mountains  of  Germany,  France. 
and  Switzerland.  Until  recently  the  part  used  officinally  was  the 
leaves.     At  present,  however,  the  root  is  preferred  as  containing  more 


326  MATERIA   MEDICA   AND  THERAPEUTICS. 

of  the  active  principle  of  the  plant,  and  is  more  uniform  in  its  strength. 
The  root  at  the  thickest  part  is  about  the  size  of  the  finger,  and  from 
four  to  five  inches  long,  with  numerous  fleshy  fibres  arising  from  it. 
"When  fresh  its  color  is  brownish  externally  and  white  internally.  Its 
smell  is  earthy,  its  taste  bitter.  After  being  chewed,  it  leaves  a  pecu- 
liar tingling  and  numbness  on  the  tongue,  lips,  and  fauces.  The  same 
effects  on  the  mouth  are  produced  by  chewing  the  leaves.  The  root 
becomes  of  a  darker  color  when  dried. 

Composition. — No  very  satisfactory  analysis  of  the  root  or  leaves  has 
yet  been  made.  They  contain,  however,  a  vegetable  alkali,  aconitina,  a 
peculiar  acid,  aconitic  acid,  and  a  volatile  acid  principle.  The  alkali 
exists  in  the  state  of  a  salt,  aconitate  of  aconitina. 

Effects. — The  effects  of  aconite  are  curious  and  peculiar.  If  a  small 
quantity  of  the  soft  alcoholic  extract  be  introduced  into  the  cavity  of 
the  peritoneum  of  a  dog,  it  usually  causes  vomiting,  lessens  the  force  of 
the  circulation,  impairs  the  muscular  power  so  as  to  cause  the  animal 
to  stagger,  and  destroys  sensibility  without  causing  stupor.  The  ani- 
mal will  sometimes  follow  its  owner  around  the  room,  recognise  him  by 
wagging  his  tail,  and  yet  be  totally  insensible  to  pinching,  pricking  with 
needles,  &c.  Before  death  slight  tremors,  but  no  regular  convulsions, 
generally  take  place.  (Pereira.)  On  the  human  subject  the  effects  are 
the  following.  If  the  leaf  or  root  be  chewed,  or  a  few  drops  of  the 
alcoholic  tincture  applied  to  the  lips,  in  a  few  minutes  a  sensation  of 
numbness  and  tingling  is  produced  in  the  part,  which  lasts  for  several 
hours.  If  the  quantity  taken  into  the  mouth  be  somewhat  large,  the 
throat  and  palate  become  affected.  Pereira  describes  the  sensation  "  as 
if  the  velum  and  soft  palate  were  elongated,  and  resting  on  the  dorsum 
of  the  tongue.  To  relieve  this,  frequent  attempts  are  made  to  swallow.1' 
When  small  and  repeated  doses  of  the  alcoholic  tincture  of  the  root 
are  swallowed,  they  cause  a  sensation  of  heat  and  tingling  in  the  extre- 
mities, and  occasionally  slight  diuresis. 

In  poisonous  doses,  the  characteristic  symptoms  are,  numbness  and 
tingling  of  the  parts  about  the  mouth  and  throat,  and  of  the  extremities^ 
vomiting^  contracted  pupil,  and  failure  of  the  circulation.  Neither  con- 
vulsion nor  stupor,  as  a  general  rule,  precedes  death. 

It  lessens  directly  the  sensibility  of  the  nerves  and  impairs  the  action 
of  the  heart.  It  is  perhaps,  therefore,  the  purest  sedative  that  we 
possess. 

The  principal  use  to  which  the  agent  has  been  applied  is  that  of  les- 
sening morbid  sensibility  of  the  nerves,  and  as  such  it  frequently  proves 
very  efficacious.  In  neuralgic  affections,  it  is  sometimes  wonderful  in 
its  effects — a  single  local  application  effecting  a  cure.  In  rheumatic 
affections  too,  unattended  by  inflammation,  it  frequently  proves  very 
useful.     The  best  form  of  it  in  these  cases  is  the  tincture,  locally  applied. 


SEDATIVES.  327 

About  a  century  ago,  this  remedy  w.'is  in  great  repute  in  a  number 
of  diseases,  such  as  scrofula,  phthisis,  cancer,  dropsy,  &C.  It,  wa-  one 
of  the  drugs  so  highly  recommended  bj  Baron  Storek  ofVienna.    After 

a  while  it  went  into  disrepute,  and  it  is  only  recently  that  its  use  has 
been  revived.  At  present  it  is  not  supposed  to  be  of  much  benefit  in 
the  diseases  in  which  it  was  so  much  landed  by  Storek. 

Preparations. — Tlie  only  preparations  which  ought  to  be  depended 
on  are  the  tincture  and  the  alcoholic  extract  and  aconitine. 

Tincture. — Take  of  the  root,  1  lb.;  alcohol,  2  pints.  Macerate  for 
14  days,  express  strongly  and  filter. 

Dose. — 5  drops  three  times  a  day.  To  be  used  with  caution.  Ap- 
plied externally  by  means  of  a  small  brush. 

Alcoholic  Extract. — U.  S.  Pha.,  |  of  a  grain  every  three  hours,  in  pill. 
Externally  in  the  form  of  ointment,  one  part  extract  and  two  of  lard, 
or  spread  on  adhesive  plaster. 

Aconitine. — This  alkali  was  first  discovered  in  1825  by  Brando  and 
Peschier. 

It  is  obtained  by  taking  the  dried  and  bruised  root  of  aconite,  and 
boiling  it  in  rectified  spirit  three  times  successively.  Then  strain  all  the 
liquors  and  let  the  spirit  distil.  Evaporate  what  remains  to  the  consist- 
ence of  an  extract.  Here  alcohol  extracts  the  aconite  from  the  root, 
and  the  extract  contains  this  principle  in  combination  with  aconitic  acid 
and  other  matters. 

Water  is  then  added  to  this  extract,  and  the  strained  liquor  is  evapo- 
rated to  the  consistence  of  syrup.  The  water  here  dissolves  out  the 
aconite  from  the  extraet. 

To  this  diluted  sulphuric  acid  and  water  are  added.  A  sulphate  of 
aconitine  is  thus  formed,  and  this  is  again  decomposed  by  the  addition 
of  a  solution  of  ammonia,  which  precipitates  the  aconitine.  In  this  state, 
however,  it  is  impure.  It  is  now  to  be  again  dissolved  in  diluted 
sulphuric  acid  and  water,  with  the  addition  of  animal  charcoal.  It  is 
then  to  be  strained,  and  the  aconitine  again  to  be  precipitated  by  a 
solution  of  ammonia.     It  is  then  to  be  washed  and  dried. 

Properties. — Aconitine  is  found  either  as  a  white  granular  substance, 
uncrystallizable,  or  in  the  state  of  a  transparent  colorless  mass,  having 
the  lustre  of  glass.  It  is  destitute  of  smell,  and  has  a  bitter  and  acrid 
taste.  This  acrid  taste,  however,  does  not  belong  to  the  aconitine, 
inasmuch  as  it  can  be  separated  from  it  by  combining  the  base  repeat- 
edly with  acids  and  decomposing  the  salt  thus  formed.  Aconitine  is 
little  soluble  in  water,  requiring  150  parts  of  cold  and  50  of  boiling 
water  to  dissolve  it.  In  alcohol  it  is  readily  soluble.  Aconitine  com- 
bines with  acids  and  forms  salts.  They  do  not,  however,  crystallize, 
but  dry  into  a  gummy  mass.     Their  taste  is  very  bitter.     The  solution 


328  MATERIA   MEDICA   AND   THERAPEUTICS. 

of  nitrate  of  aconitine  is  colorless.  That  of  the  sulphate  is  yellow  at 
first,  and  afterwards  becomes  of  a  dark  violet.  The  alkalies  decompose 
them,  precipitating  the  aconitine.  (Phillips.) 

JEjfects. — From  the  great  activity  of  this  article,  it  is  not  safe  to  use  it 
internally.  When  pure,  and  deprived  of  its  acrid  principle,  it  appears 
to  be  the  most  virulent  poison  that  we  know  of.  The  twentieth  part  of 
a  grain  dissolved  in  alcohol  will  destroy  a  bird  with  the  rapidity  of 
lightning.  This  was  done  with  Morrison's  aconitine.  The  fiftieth  part 
of  a  grain  of  the  same  killed  a  sparrow  in  a  few  minutes  (Phillips) ;  and 
the  same  quantity  nearly  proved  fatal  to  a  female  to  whom  it  was  given. 
{Pereira.) 

If  a  grain  or  two  of  aconitine,  mixed  up  with  a  drachm  of  lard  or  a 
drachm  of  alcohol,  be  rubbed  on  the  skin  of  the  forehead,  or  any  other 
tender  part  for  a  minute  or  two,  an  effect  is  produced  analogous  to  that 
of  veratrine  and  delphine.  In  some  respects,  however,  the  sensations 
differ.  Veratrine  "  produces  a  strong  sensation  of  tingling,  or  rather  a 
sharp  feeling,  similar  to  that  produced  by  receiving  a  succession  of 
electric  sparks  on  an  uncovered  part  of  the  body."  Delphine  produces 
""  a  sensation  of  burning,  not  unlike  that  which  manifests  itself  a  short 
time  after  the  application  of  a  blister,  but  to  an  unpleasant  degree." 
^Aconitine  produces  "  a  sensation  of  heat  and  prickling;"  to  this  succeed 
"  a  feeling  of  numbness  and  constriction  in  the  part,  as  if  a  heavy  weight 
were  laid  upon  it,  or  as  if  the  skin  were  drawn  together,  by  the  power- 
ful and  voluntary  contraction  of  the  muscles  beneath.  This  effect  lasts 
from  two  or  three  to  twelve  or  more  hours,  according  to  the  quantity 
rubbed  in."     (Turnbull,  p.  58.) 

Aconitine  produces  less  local  irritation  than  either  veratrine  or  del- 
phine. Indeed,  in  no  case  does  it  produce  any  more  local  excitement 
than  could  be  accounted  for  by  the  mere  friction. 

A  minute  portion  of  the  ointment  applied  to  the  eyes  causes  almost 
insupportable  heat  and  tingling,  and  contraction  of  the  pupil.  (Pereira.) 

There  are  two  forms  in  which  this  substance  is  used  as  an  external 
application,  ointment  and  solution. 

Ointment. — This  is  prepared  in  the  following  way : 
3 .  Aconitine  gr.  ij. 

Alcohol  gtt.  vi  tere  optime. 
Et  adde  Axung.   3  i  ut  fit  ung. 

If  necessary,  it  may  be  increased  to  the  strength  of  four  or  five  grains 
to  the  drachm. 

This  is  to  be  rubbed  on  the  part  until  the  pain  is  relieved,  and  may 
be  repeated  three  or  four  times  a  day,  according  to  the  effect  produced. 

With  regard  to  the  aconitine,  the  same  rule  holds  good  as  with  the 
veratrine.  Unless  it  produces  the  peculiar  effects  of  the  article  on  the 
skin,  no  good  need  be  expected  from  it. 


SEDATIVES.  329 

Solution. — One  or  two  grains  dissolved  in  a  drachm  of  alcohol.  This 
may  be  applied  by  means  of  a  small  sponge  brash. 

Care  should  be  taken  in  making  these  applications  that  the  skin  is 

not  abraded. 

[Veratrum  Album,  U.  S.  White  Hellebore. — Native  of  Central  Km  rope. 
Stem  of  long  leaf-stalks,  sheathing  each  other.  Root,  the  part  used  in 
medicine,  composed  of  root-stalk,  two  inches  long,  and  radicles.  Taste 
at  first  sweetish,  then  acrid,  bitter  and  permanent.  Its  medicinal  proper- 
tics  depend  on  the  presence  of  the  alkaloid  veratrine. 

Effects. — A  violent  irritant  poison,  causing  at  first  vomiting  and  purg- 
ing, then  stupor  and  convulsions.     Little  employed. 

Preparation. — The  best  is  the  wine.     U.  S.  P.  Dose,  gtt.  xxx  to  gtt.  xl. 

Veratrum  Viride.  American  Hellebore. — Said  to  have  been  long 
known  to  the  Aborigines,  first  introduced  into  practice  by  Dr.  Osgood  ; 
much  praised  by  Ware,  Tully,  and  others.  It  resembles  white  hellebore, 
and  like  it  contains  veratrine. 

Effects. — Resembling  hellebore,  the  less  apt  to  purge.] 


iJkAJ 


Veratrine. — This  vegetable  alkali  was  first  discovered  in  1819,  by 
Pelletier  and  Caventou,  in  the  seeds  of  the  Veratrum  sabadilla,  or  the 
Helonias  officinalis,  a  plant  growing  in  Mexico.  It  was  afterwards 
detected  by  them  in  the  roots  of  the  Veratrum  album  and  the  Colchicum 
autumnale.  What  is  used  in  medicine,  however,  is  obtained  entirely 
from  the  sabadilla  seeds. 

Mode  of  obtaining  it. — The  seeds  of  the  sabadilla  bruised  are  first 
boiled  in  alcohol,  and  this  is  repeated  three  times.  The  alcohol  here 
dissolves  out  all  Veratrine,  along  with  veratric  acid,  coloring  matter^ 
and  other  compounds. 

The  alcoholic  solution  is  then  evaporated  to  the  consistency  of  an  ex- 
tract. This  is  then  boiled  three  or  four  times  in  water,  to  which  a  little 
sulphuric  acid  has  been  added.  Here  the  veratrate  of  veratrine  is  de- 
composed, and  converted  into  the  sulphate  of  veratrine. 

The  solution  is  then  evaporated  to  the  consistence  of  a  syrup.  This 
is  then  saturated  with  magnesia,  and  afterwards  digested  with  a  gentle 
heat  in  alcohol.  Here  the  magnesia  decomposes  the  sulphate  of  vera- 
trine, and  sets  free  the  veratrine,  which  is  taken  up  by  the  alcohol.  The 
alcohol  is  then  distilled  off.  The  extract  which  remains  is  then  boiled 
in  water,  to  which  sulphuric  acid  and  animal  charcoal  are  added.  To 
the  strained  solution  ammonia  is  added,  which  throws  down  a  precipi- 
tate, which  is  to  be  separated  and  dried. 

In  the  latter  part  of  this  process,  the  sulphuric  acid  unites  with  the 
veratrine,  while  the  charcoal  abstracts  the  coloring  matter;  the  am- 


330  MATERIA   MEDICA  AND  THERAPEUTICS. 

monia  then  again  decomposes  the  sulphate,  and  throws  down  the  vera- 
trine. 

The  article  thus  prepared  is  the  one  used  in  medicine.  It  is  not,  how- 
ever, considered  as  the  pure  alkali.  It  is  a  compound  consisting  of  pure 
veratrine,  sabadilla,  resin  of  veratrine,  and  gum  resin  of  veratrine. 
(Pereira.)  .. 

Properties. — Veratrine  is  obtained  in  the  form  of  a  light  brown  or 
white  powder,  without  smell ;  taste  acrid  and  burning,  and  producing  a 
feeling  of  numbness  and  tingling,  when  applied  to  the  tongue.  In 
water,  it  is  very  sparingly  soluble,  but  sufficiently  so  to  render  the  fluid 
acrid ;  in  alcohol  and  ether,  very  soluble.  It  restores  the  blue  color  of 
litmus,  reddened  by  an  acid,  and  unites  readily  with  acids,  forming  un- 
crystallizable  salts.  When  heated,  it  melts,  and  has  the  appearance  of 
wax,  and  on  cooling  presents  a  mass  of  brownish  transparent  appear- 
ance; when  ignited  in  the  air,  it  is  decomposed  and  totally  dissipated. 

Effects. — By  Magendie,  the  following  results  were  obtained  by  expe- 
riments made  upon  animals.  A  very  small  quantity  injected  into  the 
nostrils  of  a  dog  caused  instantly  a  violent  sneezing,  which  lasted  near 
half  an  hour.  One  or  two  grains  thrown  into  the  throat  caused  a  free 
salivation,  which  continued  for  some  time.  The  same  quantity  injected 
into  any  part  of  the  intestinal  canal  produced  inflammation  of  the  part 
with  which  it  came  in  contact,  succeeded  by  vomiting  and  purging.  In 
large  doses*  it  caused  great  acceleration  of  the  circulation  and  respira- 
tion, quickly  followed  by  tetanus  and  death.  One  or  two  grains  injected 
under  the  pleura  or  tunica  vaginalis  produced  tetanus  and  death  in  ten 
minutes.  The  same  quantity  injected  into  the  jugular  vein  caused  simi- 
lar effects  in  a  few  seconds.  On  dissection,  the  mucous  membrane  of 
the  intestines  was  found  inflamed,  and  the  lungs  engorged  and  inflamed. 

In  the  human  subject,  the  smallest  quantity  taken  into  the  mouth  causes 
free  salivation,  and  if  applied  to  the  nostrils,  produces  violent  sneezing. 

When  given  internally  in  medicinal  doses,  a  sensation  of  warmth  is 
produced  in  the  stomach,  which  gradually  extends  itself  over  the  abdo- 
men and  lower  parts  of  the  chest,  and  afterwards  to  the  head  and  extre- 
mities. If  the  medicine  be  continued,  a  sense  of  tingling  is  felt  in  dif- 
ferent parts  of  the  body,  and  sometimes  over  the  whole  surface,  accom- 
panied frequently  by  perspiration  and  a  sense  of  oppression.  To  this 
succeeds  a  sensation  of  coldness,  and  if  the  medicine  be  still  continued, 
nausea  and  vomiting  take  place ;  sometimes  looseness  and  only  occa- 
sionally purging  are  produced.  Generally  the  force  and  frequency  of 
the  pulse  are  diminished  under  its  use,  but  no  narcotic  effects  take  place. 
When  applied  externally,  in  the  form  of  ointment  rubbed  on  the  skin,  as 
a  general  rule,  no  local  irritation  is  caused.  In  some  cases  a  slight  blis- 
ter, and  in  others  an  eruption  appear  on  the  part.  The  first  effect  ex- 
perienced is  a  sense  of  warmth  and  tingling  in  the  part,  and,  according 


SEDATIVES.  88] 

to  Turnbull,  until  this  is  produced,  no  effect  is  experienced  from  the  medi- 
cine. This  is  agood  criterion  to  judge  of  the  purity  of  the  article.  After 
the  ointment  has  been  applied  a  sufficient  length  of  time  to  influence  the 
system,  the  heat  and  tingling  extend  over  the  whole  surface,  and  the 
same  sensations  are  produced  as  those  accompanying  its  internal 
The  pulse  is  also  affected  as  by  the  internal  use.  Applied  endermiailh/ 
the  effects  are  still  more  decided,  but  the  local  irritation  is  so  great  as 
to  preclude  its  use. 

Form  of  Administration.' — In  consequence  of  its  acrid  taste,  the  best 
form  of  giving  it  is  that  of  pill.  The  formula  recommended  by  Turn- 
bull  is  the  following : 

1},      Veratrine  grs.  ij. 

Ext.  hyoscyam.  grs.  vi. 
Pulv.  rad.  glycyr.  grs.  xii.     M. 
Divide  into  twelve  pills — one  three  times  a  day. 

Tincture. — Magendie  directs  four  grs.  to  be  dissolved  in  one  ounce  of 
alcohol.  Of  this  he  advises  from  ten  to  twenty-five  drops  to  be  given  in 
a  cup  of  broth  as  a  substitute  for  the  tincture  of  colchicum. 

As  external  applications,  it  may  be  used  either  in  the  form  of  oint- 
ment or  tincture. 

The  ointment  is  the  best.  This  is  made  by  rubbing  up  from  fifteen 
grs.  to  3  ss  veratrine,  with  3  i  of  olive  oil  and  §  i  of  lard.  Of  this  a 
piece  as  big  as  a  nut  is  to  be  rubbed  with  the  hand  for  ten  or  fifteen 
minutes  on  the  part  affecte.-i.  In  doing  this,  care  should  be  taken  that 
the  skin  be  not  broken  or  lenuded,  otherwise  great  irritation  will  be 
produced.  Where  the  ointvrmnt  cannot  be  used,  a  tincture  made  of 
3  i  veratrine  to  §  ij  of  alcohol  way  be  applied  in  the  same  way. 

Besides  the  alkali  itself,  the  tartrate,  acetate,  and  sulphate,  have  been 
used.     They  produce  the  same  effects,  and  are  given  in  the  same  doses. 

Diseases  in  which  Veratrine  has  been  used. — The  diseases  in  which  it 
has  been  used  by  Dr.  Turnbull,  and  as  he  says  with  advantage,  are:  1. 
Affections  of  the  heart,  unattended  by  organic  disease ;  2.  Neuralgic 
affections.  In  these  it  seems  to  exert  its  power  in  the  most  striking 
manner.  In  some  cases  a  single  friction  gives  entire  relief.  3.  In  chro- 
nic rheumatism  ;  4.  Gout ;  5.  Dropsy.  In  this  case  it  operates  by  pro- 
moting the  flow  of  urine.  In  all  of  the  foregoing  cases,  the  remedy  was 
applied  externally. 

Delphine. — This  was  first  discovered  in  1819,  by  MM.  Lassaigne 
and  Fenuelle.  It  exists  in  the  seeds  of  the  stavesacre  (Delpkinum 
staphisagria)  in  combination  with  delphinic  acid. 

The  mode  of  obtaining  it,  recommended  by  M.  Couerbe,  is  the  follow- 
ing : — a  saturated  tincture  of  the  seeds  is  to  be  evaporated  to  the  con- 
sistence of  a  thin  extract,  and  heated  with  water  acidulated  by  sulphuric 

22 


332  MATERIA   HEDICA   AND  THERAPEUTICS. 

acid.  This  solution,  when  filtered,  is  to  be  precipitated  by  ammonia.  The 
precipitate,  after  being  freed  from  its  water,  is  to  be  taken  up  with  alcohol, 
and  again  reduced  to  the  consistence  of  extract,  which  is  likewise  to  be 
dissolved  in  acidulated  water.  To  this  solution,  when  filtered,  a  small 
quantity  of  nitric  acid  is  to  be  added,  as  long  as  any  precipitate  falls.  The 
liquid  freed  from  this  precipitate  is  again  to  be  thrown  down  by  ammo- 
nia and  the  powder  dried.     (Turnbull,  p.  49.) 

This  is  the  delphine  of  commerce.  Like  veratrine,  however,  this  is  a 
compound  substance,  consisting  of  delphine,  resinous  matter,  and  staphis- 
acre  (an  acrid  resin).  To  obtain  the  delphine  separately,  dissolve  in  ether. 
This  takes  up  the  delphine,  but  leaves  the  others. 

Properties. — When  pure,  delphine  is  in  a  state  of  white  powder, 
without  smell,  but  has  a  bitter  and  acrid  taste.  It  is  very  sparingly 
soluble  in  water,  whether  hot  or  cold.  It  nevertheless  imparts  its  bitter 
taste  to  the  water.  In  ether  it  is  soluble,  and  still  more  so  in  alcohol. 
Its  solutions  in  these  fluids  have  the  property  of  rendering  syrup  of 
violets  green,  and  of  restoring  the  blue  color  of  litmus  when  reddened 
by  acid.  It  unites  with  the  acids,  forming  salts  which  are  bitter  and 
acrid,  and  crystallizes  with  great  difficult}7.  When  heated,  it  melts  and 
resembles  wax  in  its  appearance.     On  cooling  it  is  brittle  like  resin. 

Effects. — In  doses  of  half  a  grain,  repeated  three  or  four  times  a  day, 
delphine  may  be  given  without  producing  any  irritation  of  the  stomach. 
In  some  cases  it  operates  on  the  bowels,  and  most  usually  causes  an 
increased  flow  of  urine.  When  taken  to  thx  extent  of  a  few  grains,  it 
gives  rise  to  sensations  of  heat  and  tingling  jvi  various  parts  of  the  body, 
analogous  to  those  produced  by  veratrine.    ■ 

In  large  doses,  it  is  a  narcotico-acrid  poison.  The  salts  of  delphine 
act  in  the  same  manner  as  the  pure  alkali. 

When  applied  externally,  in  the  shape  of  ointment  or  solution,  it 
causes  a  sensation  of  burning,  resembling  very  much  the  effect  produced 
by  a  blister  a  short  time  after  it  has  been  applied.  In  almost  every 
case  it  causes  a  blush  of  redness  on  the  surface  to  which  it  is  applied. 
In  this  respect  it  differs  from  veratrine,  which  causes  no  redness. 
Besides  this,  the  local  effect  of  delphine  is  more  permanent  than  that 
of  veratrine. 

Test  of  the  goodness  of  Delphine. — Turnbull  lays  down  the  rule  that 
unless  a  solution  of  it  in  alcohol,  in  the  proportion  of  four  grs.  to  the 
drachm,  produce  a  sense  of  heat  and  pricking,  after  being  rubbed  on  the 
forehead  for  three  or  four  minutes,  it  is  not  good  and  ought  not  to  be  used. 

Form  of  Administration. — Internally,  it  may  be  given  in,  pill. 
IJ     Delphine,  gr.  i. 

Extract  hyoscyamus, 

Extract  glycyrrhizae,  aa  grs.  12. — 12  pills. 

One  to  be  taken  every  three  or  four  hours. 


rSKDATIVKS. 

It  is  generally,  however,  used  as  an  external  application  either  as  oint- 
ment or  solution,  in  the  proportion  of  from  10  to  80  grs.  to  the  Onn< 
lard  or  alcohol. 

These  are  to  be  rubbed  on  in  tlic  same  way  as  tlie  veratrine,  from  10 
to  20  minutes,  or  until  the  peculiar  tingling  sensation  is  caused  in  the 
part,  and  this  is  to  be  repeated  three  or  four  times  a  day. 

Diseases  in  which  Delphine  is  used. — In  its  general  effects,  delphine 
resembles  veratrine,  and  has  been  used  in  the  same  affections.  Chiefly 
used  in  neuralgic  affections,  paralysis,  and  rheumatism. 

ACTCEA    RACEMOSA. 

Known  by  various  other  names,  as  Cimifuga  racemosa,  Cimifuga  ser- 
pentaria,  Macrotys  racemosa,  and  by  the  common  names  of  black  snake 
root,  cohosh,  squaw  root. 

This  plant  grows  from  four  to  six  or  eight  feet  high.  It  is  found 
native  in  many  parts  of  the  United  States,  from  Canada  to  Florida.  It 
flowers  in  June  and  July.  The  part  used  is  the  root,  which  is  perennial. 
As  found  in  the  shops  it  consists  of  a  rough,  tuberculated  head,  with 
numerous  radicles,  sometimes  several  inches  long.  These  radicles  are 
brittle,  and  easily  separated.  The  color  of  the  root  is  blackish  exter- 
nally, and  white  internally.  It  has  little  smell,  its  taste  is  bitter  and 
somewhat  astringent,  leaving  a  sense  of  acrimony  on  the  palate.  The 
proper  time  for  gathering  &e  root  is  late  in  the  summer  or  in  the  autumn. 
Its  sensible  properties  are  ^id  to  depend  a  good  deal  upon  the  time  of 
gathering,  mode  of  drying,  aQ. 

According  to  the  analysis  oi  Mr.  Tilghman,  it  contains  fatty  matter, 
gum,  starch,  resin,  green  coloring  matter,  tannin,  tvax,  gallic  acid,  sugar, 
oil,  lignin,  with  salts  of  lime,  iron,  magnesia,  and  jjotassa. 

The  virtues  are  yielded  to  water  and  alcohol. 

Effects. — In  its  general  action  on  the  system,  this  article  appears  to 
resemble  very  much  the  colchicum.  It  promotes  the  secretions  of  the 
mucous  membrane,  and  at  the  same  time  produces  an  impression  on  the 
nervous  system,  and  lowers  the  action  of  the  heart  and  arteries. 

It  is  very  much  used  by  many  American  practitioners  in  rheumatism, 
and  is  said  very  often  to  produce  excellent  effects.  It  has  also  been  used 
in  some  nervous  affections,  as  chorea.  It  had  at  one  time  great  reputa- 
tion in  affections  of  the  lungs,  as  humoral  asthma,  chronic  bronchitis  ;  it 
was  even  said  to  have  cured  phthisis.  That  it  may  do  good  in  the 
former  cases  is  probable  ;  in  the  latter,  certainly  not. 


334  MATERIA  MEDICA   A3STD   THERAPEUTICS, 


Cold. 

Cold  is  used  in  medicine  to  produce  two  very  different  effects,  which 
may  be  called  its  immediate  and  its  secondary  effects.  The  immediate 
effects  of  cold  are  to  depress  vital  action  ;  it  is  one  of  the  purest  and 
most  indisputable  of  sedatives ;  but  cold  is  much  more  frequently  used 
in  the  treatment  of  disease  with  a  view  to  its  secondary  effect,  or  to  the 
reaction  which,  when  not  too  intense  nor  too  long  continued,  it  provokes. 
It  is  with  the  former  of  these  uses  of  cold  that  we  are  now  to  deal. 

Cold  as  a  sedative  is  used  either — 

1.  To  reduce  the  temperature  of  the  part  to  which  it  is  applied,  or  of 
the  whole  system. 

2.  To  repress  vital  action,  especially  the  action  of  the  heart  and 
arteries. 

The  first  of  these  uses  of  cold  will  be  considered  when  I  speak  of  re- 
frigerants, and  the  use  and  value  of  the  remedy  appreciated ;  it  is  with 
the  latter  or  the  proper  sedative  effects  of  cold  that  we  have  now  to  do. 
Cold,  then,  is  used  to  repress  vital  action  in  internal  inflammations, 
especially  of  the  brain  ;  the  mode  of  applying  it  is  either  by  cloths  wet 
with  cold  water,  by  ice  applied  to  the  head,  or  by  freezing  mixtures.  As 
to  the  use  of  cold  cloths,  I  remark  that  their  value,  indeed  their 
safety,  depends  altogether  on  the  manner  in  which  they  are  used.  If 
the  water  used  is  quite  cold,  and  the  cloths  are  changed  often  enough  to 
keep  the  heat  of  the  part  down,  nothing  but  cjood  can  result ;  but  if,  on 
the  contrary,  the  water  be  only  moderate/  cold,  and  the  cloths  be 
allowed  to  remain  on  long  enough  to  bec6me  warm,  reaction  takes  place 
after  each  application,  and  the  art  of  man  could  scarce  contrive  a  more 
mischievous  agent.  This  is  a  very  great  objection  to  the  use  of  this 
agent  in  this  way.  Everything  depends  on  the  nurse,  and  she  is  not 
always  a  safe  dependence. 

Ice  to  the  head. — This  is  generally  applied  in  a  bladder ;  it  is  free  from 
the  objection  which  I  have  stated  against  cold  cloths,  and  if  decent  care 
be  taken  it  will  always  do  good,  and  never  harm.  The  only  way,  indeed, 
in  which  it  can  do  harm,  is  by  depressing  the  vital  powers  below  the 
standard  of  life,  and  causing  either  fatal  prostration  of  the  whole  system, 
or  gangrene  of  the  part  to  which  it  is  immediately  applied.  To  guard 
against  this  remember — 

1.  The  class  of  patients  most  obnoxious  to  this  kind  of  mischief  are 
those  whose  powers  are  reduced,  and  whose  capacity  of  generating  heat 
is  small.  The  two  extremes  of  life  present  us  with  illustrations  of 
these  states.  The  old  man's  powers  are  worn  out,  he  resists  cold  badly, 
his  circulation  is  languid,  his  extremities  are  more  likely  to  give  way 
under  the  local  effects  of  cold.     On  the  other  hand,  the  young  child, 


>IU)ATIVE8.  835 

especially  the  infant,  has  but  a  moderate  power  of  producing  animal 

heat,  and  besides  liis  vital  powers  are  weak.    He,  too,  resists  cold  badly. 

But,  aside  from  age,  constitutions  differ,  and  of  course  the  feeble,  the 

ill-nourished,  the  depressed,  and  those  whose  vital  powers  are  failing 

under  the  influence  of  severe  disease,  will  suffer  most  from  intense  cold. 
The  rule  to  be  observed  for  all  these  facts  is  -imply  to  moderate  the 
degree  of  cold  which  you  use  to  persons  who  from  age  or  constitution 
are  ill  able  to  bear  up  against  it,  and  to  watch  the  effect  of  cold  applica- 
tions in  such  patients,  and  indeed  in  all  patients.  With  these  guards  the 
application  of  the  ice  poultice  (so  called)  may  be  resorted  to  in  inflam- 
mation of  the  brain  with  the  best  effects.  The  freezing  mixtures  are 
only  to  be  used  as  substitutes  for  the  ice  bag-  If  it  is  desirable  early  in 
an  attack  to  make  a  very  strong  impression  on  the  cerebral  circulation, 
this  can  be  done  by  pouring  from  a  height  ice-cold  water  on  the  head. 
This  is  a  remedy  of  great  power,  and  should  be  used  with  caution.  It 
is  not  proper  where  serious  organic  mischief  is  suspected.  It  must  not 
be  long  continued  (three  to  five  minutes  is  enough). 

2.  Great  care  should  be  taken  to  prevent  excessive  reaction  after  the 
cold  dash  by  immediately  applying  to  the  head  either  cold  cloths  or  the 
ice  bag,  and  keeping  it  there  for  some  time,  watching  always  its  effects, 
and  removing  the  ice  if  it  seem  likely  to  endanger  the  vitality  of  the 
scalp,  or  the  vigor  of  the  general  system. 

To  Local  Inflammations,  the  results  of  injury,  cold  water  is  an  admir- 
able remedy.  Here  the  great  art  is  to  apply  the  cold  in  a  moderate 
degree,  but  continue  it  for  a  very  long  time.  This,  however,  belongs 
rather  to  surgery  than  to  i  ^dicine. 

Internal  use  of  Cold  as  <i  Sedative. — 'This  is  resorted  to  in  fevers,  and 
especially  in  gastric  inflammations.  In  fevers,  cold  water  taken  very 
freely  is  the  form  in  which  cold  is  best  administered,  because  here  you 
have  with  the  sedative  the  action  of  that  best  of  diuretics,  water. 

In  Gastric  Inflammations. — Here  ice  may  be  given,  and  with  the 
very  best  effects  ;  the  feelings  of  the  patient  are  the  best  guide  as  to  the 
quantity,  and  it  is  very  rarely  necessary  to  put  any  restraint  upon  him 
in  respect  to  what  the  Germans  call  ice  pills.  The  most  admirable  effects 
often  follow  the  very  free  use  of  ice  and  iced  water. 

In  Puerperal  Peritonitis. — When  thirst  is  urgent,  the  use  of  ice  will 
do  more  than  any  other  agent  to  quiet  the  distressing  nausea  and  allay 
the  burning  thirst  which  add  so  much  to  the  sufferings  of  the  patient. 
Michaelis  of  Kiel  has  recommeuded  the  free  application  of  ice  in  blad- 
ders to  the  abdomen,  while  ice  was  taken  by  the  mouth.  In  his  hands 
the  practice  was  very  successful. 


EEFEIGEEANTS 


Refrigerants  are;  those  agents  which  possess  the  property  of  lessen- 
ing animal  heat  when  preternaturally  increased.  They  are  sometimes 
called  Tenqierants,  from  their  lesseuing  excitement.  From  the  fact  of 
their  being  used  in  inflammatory  affections,  they  are  sometimes  also 
called  Antiphlogistics.  The  term  refrigerant  is,  however,  perhaps  the 
best.  It  is  not  my  intention  to  go  into  any  account  of  the  various 
theories  which  have  been  offered  in  relation  to  the  modus  operandi  of 
this  class  of  agents,  Ingenious  as  many  of  these  are,  they  are  never- 
theless unsatisfactory. 

The  effects  of  refrigerants  are  simple  and  obvious.  They  lessen 
animal  heat  and  moderate  the  action  of  the  heart  and  arteries.  It  is 
to  be  observed,  however,  that  they  do  this,  if  in  any  marked  extent, 
only  when  the  heat  and  circulation  are  above  the  natural  standard.  In 
the  ordinary  condition  of  the  system  they  produce  no  very  sensible 
effects.  The  individual  articles  of  this  cl^'iS  are  not  numerous,  and 
they  may  be  divided  into  three  classes — 1 ..  kcids  ;  2.  Salts  ;.  3.  Cold. 

Vegetable  Acids — Possess  refrigerant  properties  in  a  considerable 
degree.  Those  most  used  are  the  citricr  acetic,  tartaric,  and  malic.. 
Most  commonly  these  are  not  used,  except  as  they  exist  in  certain  vege- 
table productions  in  which  they  abound.  These,  therefore,  will  be 
briefly  noticed. 

Lemon. — This  is  th«  product  of  the  Citrus  limonum  or  lemon  tree, 
a  native  of  Asia,  and  from  thence  introduced  into  Europe.  It  is  now 
cultivated  extensively  in  the  south  of  Europe  and  in  the  East  and  West 
Indies.  The  Spanish  lemon  is  considered  the  best.  The  juice  of  the 
lemon  consists  of,  in  100  parts,  citric  acid  1.77,  malic  acid,  gum  and 
bitter  extractive  0.72,  water  97.51.  The  form  in  which  this  article  is 
used  is  that  of  ordinary  lemonade,  and  in  that  state  it  affords  not  only 
one  of  the  most  agreeable  but  valuable  refrigerant  drinks. 

In  combination  with  the  bicarbonate  of  soda  it  is  used  for  the  pur- 
pose of  making  the  effervescing  draught.  A  simple  way  of  preparing 
this  is  to  take  3  ss  of  lemon  juice,  diluted  with  an  equal  quantity  of 
water,  and  add  to  this  a  solution  of  15  or  20  grs.  of  bicarbonate  of  soda 


REFRIGERANTS.  3  3  V 

in  ?  ss  of  water.     To  be  taken  in  1  lie  act  of  effervescence.     Bi 

being  refrigerant,  this  is  a  grateful  stimulant  to  the  Btomacfa  in  <■■■> 
nausea  and   vomiting.       It   is  also  diaphoretic  and   diuretic.       Here  a 
citrate  of  soda  is  formed,  while  the  carbonic  acid  is  diffused  through  the 
water. 

Orange. — This  is  the  product  of  the  Citrus  aurantium,  a  native  of 
Asia,  but  cultivated  in  the  south  of  Europe,  in  the  West  Indies,  and  in 
Florida.  The  juice  consists  of  citric  acid,  malic  acid,  aaicihij/c,  alhiuam, 
sugar,  citrate  of  lime,  and  water. 

This  is  a  most  grateful  refrigerant,  allaying  thirst  and  lessening  heat. 

Citric  Acid. — This  acid  is  peculiar  to  the  vegetable  kingdom,  and 
was  first  obtained  in  the  solid  state  by  Scheele  in  1781.  It  is  found  in 
the  juice  of  many  acid  fruits,  generally  in  a  free  state,  but  sometimes  in 
combination  with  potash  and  lime.  It  is  found  in  the  fruits  of  the 
genus  citrus,  in  the  cranberry,  whortleberry,  gooseberry,  red  currant, 
strawberry,  raspberry,  cherry,  mixed  with  equal  quantities  of  malic  acid. 
In  the  tamarind  it  exists  both  with  malic  and  tartaric  acids. 

It  is  always  obtained  from  the  juice  of  the  lemon  and  lime.  It  crys- 
tallizes in  colorless  rhomboidal  prisms,  Avhich  are  slightly  affected  by 
exposure  to  a  moist  air.  It  is  exceedingly  acid,  but  destitute  of  smell. 
It  is  soluble  both  in  hot  and  cold  water,  and,  in  small  proportions,  in 
alcohol. 

Citric  acid  answers  as  a  substitute  for  lime  juice  when  that  article 
cannot  be  procured.  Nine  drachms  and  a  half  of  the  acid  dissolved  in 
a  pint  of  distilled  water  form  a  solution  equal  in  strength  to  recent  lime 
juice. 

Of  this  solution  or  of  lemon  juice  3j  of  bicarbonate  of  potassa  satu- 
rates 3  iijss,  3j  of  carbonate  of  potassa  3  iv,  and  3j  of  carbonate  of 
ammonia  3  vi.  A  scruple  of  the  acid  dissolved  in  a  pint  of  water,  and 
sweetened  with  sugar  which  has  been  rubbed  on  fresh  lemon  peel, 
makes  a  good  substitute  for  lemonade. — U.  S.  Disp. 

Tamarinds. — This  is  the  product  of  the  Tamarindus  Indicus,  a  large 
tree  growing  native  in  the  East  Indies,  Egypt,  and  Arabia,  and  from 
thence  transplanted  in  the  West  Indies.  In  every  part  of  India  this 
tree  is  common,  and  in  all  the  Eastern  islands  it  grows  luxuriantly. 
According  to  Ainslee,  it  is  in  Java  that  it  attains  the  greatest  perfection, 
and  is  an  exceedingly  beautiful  tree. 

The  fruit  is  a  broad  ash-colored  pod,  from  two  to  six  inches  long, 
containing  numerous  seeds,  surrounded  by  a  viscid  pulpy  matter. 
Tamarinds  are  chiefly  brought  here  from  the  West  Indies,  where  they 
are  prepared  by  placing  the  pods,  previously  deprived  of  their  shells,  in 


338  MATERIA   MEDIC  A  AND   THERAPEUTICS. 

layers  in  a  suitable  vessel,  and  then  pouring  boiling  syrup  over  them. 
This  congeals  on  becoming  cool. 

Fresh  tamarinds  have  a  pleasant  acid  taste,  without  any  sweetness. 
As  brought  to  this  country  they  are  in  the  form  of  a  dark-colored  mass, 
with  a  sweet  acidulous  taste.  According  to  the  analysis  of  Vauquelin, 
the  pulp  of  the  prepared  tamarind  contains  in  100  parts  (besides  the 
sugar  which  is  added),  citric  acid,  9.40  ;  tartaric  acid,  1.55  ;  malic  acid, 
0.45 ;  super-tartrate  of  potassa,  3.25  ;  gum,  4.70  ;  gelatine  or  jelly, 
6.25  'parenchymatous  matter,  34.35  ;  water,  27.55. 

Sometimes  copper  is  also  detected  in  them.  This  is  supposed  to  be 
owing  to  the  vessels  in  which  they  are  frequently  prepared.  This  may 
easily  be  ascertained  by  inserting  a  smooth  iron  blade  in  them.  If  cop- 
per be  present  a  reddish  crust  will  form  on  the  blade. 

Effects. — Tamarinds  are  agreeably  acid  and  refrigerant.  If  taken  in 
sufficient  quantities  they  also  prove  laxative.  The  common  form  of 
using  them  is  that  of  tamarind  water,  made  by  infusing  boiling  water 
on  the  prepared  pulp. 


This  is  called  Acetum,  or  the  Acidum  aceticum  irnpurum,  a  peculiar 
fluid  obtained  from  certain  liquors  undergoing  the  acetous  fermentation. 
In  wine  countries  it  is  obtained  from  vinous  liquors,  but  in  this  country 
it  is  usually  obtained  from  beer  and  cider.  In  its  color,  vinegar  varies 
from  a  yellow  to  a  deep  red,  according  as  it  is  prepared  from  white  or 
red  wine. 

According  to  analysis  vinegar  consists  chiefly  of  acetic  acid  and 
water,  in  the  proportion  of  five  parts  of  the  first  to  ninety-five  of  the 
second.  Besides  these,  it  contains  various  impurities  derived  from  the 
liquors  from  which  it  is  prepared,  such  as  gum,  starch,  malic  and  tar- 
taric acids,  coloring  matter,  a  little  alcohol,  and  small  proportions  of 
alkaline  and  earthy  salts. 

Properly  diluted,  vinegar  forms  an  excellent  refrigerant  drink,  although 
not  so  agreeable  as  the  other  vegetable  acids,  and  on  that  account  not 
so  much  used.  As  an  addition  to  gargles,  it  is  frequently  very  useful 
as  an  astringent ;  as  an  external  application,  largely  diluted  with  water, 
it  is  very  valuable  for  sponging  the  surface,  for  the  purpose  of  lessening 
morbid  heat. 

Cold. — This  is  the  most  decided  refrigerant  that  we  know  of;  and 
in  many  cases  is  most  advantageously  applied  in  the  management  of 
disease.  It  may  be  applied  in  various  ways.  1.  In  the  shape  of  Gold 
air ;  2.  Cold  water  taken  internally  and  externally;  3.  Ice  applied 
externally  and  taken  internally. 


KEFRIGEHANTS.  339 


I'KACTH'AI,     APPLICATION      IN     TIIK     Til  K  ATM  KN  I      OK     DISK  A  SKS. 

1.  Fevers. — Whatever  difference  of  opinion  may  have  existed  at  one 
time  in  relation  to  the  use  of  refrigerants  in  febrile  affections,  scarcely 
any  exists  at  present.  That  there  ever  should  have  been  any  doubt  on 
the  subject  seems  strange  enough.  If  refrigerant  agents  posses^  the 
power  of  lessening  morbid  heat,  moderating  the  action  of  the  heart  and 
arteries,  and  allaying  thirst,  one  would  suppose  that  common  Bense  as 
well  as  reason  would  have  sanctioned,  if  not  suggested,  the  propriety  of 
their  use  in  fever.  In  the  practice  of  the  present  day  they  are  gene- 
rally resorted  to,  and  may  be  used  with  great  advantage  in  all  fevers, 
where  the  object  is  to  diminish  morbid  heat  and  moderate  the  circula- 
tion. In  many  cases,  too,  they  are  the  best  remedies  which  can  be 
used  for  the  purpose  of  quieting  irritability  of  the  stomach.  »In  some 
of  the  forms  of  fever  in  which  this  is  a  prominent  symptom,  besides  the 
ordinary  effervescing  draughts,  cold  water  and  ice  in  small  pieces  are 
among  our  most  efficient  agents. 

The  Jiistory  of  the  use  of  cold  water  in  fever  is  very  interesting. 
Among  the  ancients  it  was  a  practice  by  no  means  uncommon.  It  was 
used  by  Hippocrates;  and  Galen,  who  wrote  extensively  on  the  use  of 
water,  recommends  in  the  highest  terms  the  administration  of  cold 
drinks,  and  even  immersion  in  the  cold  bath,  in  cases  of  ardent  fever. 
The  form  of  affusion,  however,  as  practised  in  modern  times,  does  not 
appear  to  have  been  known  to  them,  and  their  practice,  such  as  it  was, 
seems  never  to  have  been  established  upon  any  scientific  or  philoso- 
phical principles.  Accordingly,  like  all  other  remedies  used  empi- 
rically, it  sank  before  the  wave  of  varying  opinions  and  successive  theo- 
ries, and  eventually  was  completely  lost  in  the  medical  practice  of  the 
civilized  world.  Among  some  of  the  ruder  nations  of  Asia  and  Africa 
traces  of  it  were,  however,  to  be  met  with.  Lavary,  who  travelled  in 
Egypt,  says  it  is  customary  for  the  inhabitants,  when  attacked  by  fever, 
to  bathe  in  the  Nile;  and  Bruce,  the  celebrated  traveller,  states  it  to 
have  been  common  among  the  Abyssinians.  The  first  regular  and  sys- 
tematic notice  that  we  have  of  the  practice,  however,  was  in  the  early 
part  of  the  last  century,  by  De  Hahn,  by  whom  it  was  extensively  used 
in  an  epidemic  fever  of  a  typhoid  character,  which  prevailed  in  Breslau, 
in  Silesia,  in  the  year  1737.  The  manner  in  which  the  water  was 
applied  was  by  means  of  "  sponges  soaked  in  cold  water  to  every  part 
of  the  surface  in  succession."  In  general,  it  was  not  resorted  to  until 
the  eighth  or  ninth  day  of  the  disease,  or  when  the  case  was  becoming 
desperate  from  the  failure  of  other  remedies.  Applied  in  this  way,  it 
must  have  frequently  done  more  harm  than  good ;  at  any  rate,  the 
practice  made  no  progress. 


340  MATERIA   MEDICA  AND   THERAPEUTICS. 

It  was  reserved  for  Dr.  William  Wright,  a  British  physician,  who 
had  resided  previously  in  the  West  Indies,  to  revive  the  practice.  In 
the  year  1777,  while  on  his  passage  from  the  West  Indies  to  Liverpool, 
he  was  seized  with  a  fever  which  prevailed  on  board  the  vessel.  Hav- 
ing tried  various  remedies,  but  without  effect,  and  finding,  too,  that 
whenever  he  got  upon  deck  he  felt  better,  and  that  just  in  proportion 
to  the  coldness  of  the  air,  he  determined,  as  he  says,  "  to  put  in  practice 
on  himself  what  he  had  often  wished  to  try  on  others  in  fevers  similar 
to  his  own."  Accordingly,  on  the  fifth  day  of  the  disease,  he  pursued 
the  following  treatment,  which  I  shall  give  in  his  own  words  : 

"  Sept.  9.  Having  given  the  necessary  directions,  about  three  o'clock 
in  the  afternoon  I  stripped  off  all  my  clothes,  and  threw  a  sea  cloak 
loosely  about  me  till  I  got  upon  deck,  when  the  cloak  was  also  laid 
aside  ;  three  bucketfuls  of  salt  water  were  then  thrown  at  once  upon 
me  ;  the  shock  was  very  great,  but  I  felt  immediate  relief.  The  head- 
ache and  other  pains  instantly  abated,  and  a  fine  glow  and  diaphoresis 
succeeded.  Towards  evening,  however,  the  same  febrile  symptoms 
threatened  a  return,  and  I  had  again  recourse  to  the  same  method  as 
before,  with  the  same  good  effect.  I  now  took  food  with  an  appetite, 
and  for  the  first  time  had  a  good  night's  rest. 

"  Sept.  10.  No  fever,  but  a  little  uneasiness  in  the  hams  and  thighs — 
used  the  cold  bath  twice.    - 

"Sept.  11.  Every  symptom  vanished;  but  to  prevent  a  relapse,  I 
used  the  cold  bath  twice." 

Another  person  seized  on  board  with  the  fever  was  treated  in  the 
same  way,  and  with  like  success. 

The  account  from  which  the  foregoing  is  drawn  was  published  by  Dr. 
Wright  in  17&7  in  the  London  Medical  Journal ;  and  it  was  this  simple 
narrative  which  struck  the  eye  of  Dr.  Currie,  and  suggested  the  hints 
which  afterwards  led  to  the  ingenious  and  beautiful  investigations  of  this 
subject  by  that  elegant  scholar  and  accomplished  physician.  Thus  it  is 
that  men  of  genius,  seizing  the  rude  ideas  of  inferior  minds,  have  con- 
structed theories  and  perfected  discoveries,  which  have  rendered  their 
names  immortal. 

Having  received  the  commendation  of  such  high  authority,  as  might 
naturally  be  expected,  the  remedy  became  exceedingly  popular,  and  was 
extensively  used,  more  especially  in  hospital  practice,  by  Drs.  McLean, 
Jackson,  and  others.  Undergoing  the  same  vicissitudes  which  have  so 
strikingly  marked  the  history  of  our  art,  it  has  again  fallen  into  disre- 
pute. Believing  it,  nevertheless,  to  be  a  remedy  of  value,  it  may  not  be 
useless  to  designate  the  leading  principles  which  should  govern  its  use 
in  fever.  , 

1.  It  ought  not  to  be  used  in  the  cold  stage  of  fever.  The  internal 
organs  are  already  in  a  state  of  oppression,  and  unable  to  react  upon  the 


KEFKIQKKANTS.  84  I 

blood  thrown  into  them,  in  this  condition  of  things  the  application  of 
cold  to  tlio  surface  will  still  further  increase  the  oppression,  and  the  con- 
sequence may  even  be  fatal  to  the  patient. 

2.  It  should  never  be  used  when  the  heat  of  the  system  is  not  - 
than  natural.  In  judging  of  the  degree  of  heat,  it  should  Dot  bd  deter- 
mined merely  by  the  feelings  of  the  patient,  but  by  actual  measurement 
with  a  thermometer.  For  this  purpose  the  bulb  of  a  small  thermometer 
should  be  placed  under  the  tongue,  or  in  the  axilla.  The  heat  in  these 
two  places  corresponds  exactly,  and  will  indicate  the  heat  of  the  surface 
of  the  body,  where  covered  from  the  contact  of  the  external  air. 

3.  It  should  never  be  used  when  the  patient  is  in  a  state  of  perspira- 
tion. The  reason  must  be  obvious.  It  interferes  with  a  process  which 
is  most  effectually  lessening  febrile  heat  and  excitement,  at  the  same 
time  that  it  would  drive  the  fluids  upon  the  internal  organs  when  they 
are  not  in  a  suitable  condition  for  reaction. 

4.  It  should  never  be  used  when  local  inflammation  or  congestion  of 
some  internal  organ  is  present.  Both  would  inevitably  be  aggravated  by  it. 

5.  It  should  never  be  used  in  the  advanced  stages  of  fever,  where 
there  is  great  debility,  and  where  the  heat  of  the  system  is  already 
much  reduced. 

Under  these  restrictions  this  remedy  may  be  used  with  great  advan- 
tage in  fevers,  and  the  suitable  period  for  it  is  when  the  exacerbation  is 
at  its  height. 

In  continued  fever  this  generally  takes  place  towards  evening.  Gene- 
rally speaking,  it  will  prove  most  efficacious  if  used  in  the  earlier  stages 
of  the  disease. 

In  applying  this  remedy  certain  precautions  are  necessary.  Salt  wa- 
ter is  preferable  to  fresh,  as  it  produces  greater  reaction,  and  the  tempe- 
rature of  it  should  be  about  40°.  The  patient  is  to  be  placed  on  a  stool 
in  a  large  tub,  and  a  bucketful  of  water  is  to  be-  poured  over  his  head 
and  shoulders.  He  is  then  to  be  rubbed  dry  and  put  into  bed.  If  the 
remedy  agrees  with  him,  it  will  be  found  in  a  short  time  afterwards  that 
the  heat  is  diminished,  the  pulse  lessened  in  frequency,  and  indeed  all 
the  febrile  symptoms  are  annihilated.  If  these  effects  should  be  pro- 
duced, it  may  with  safety  be  repeated  whenever  the  febrile  exacerbation 
comes  on. 

Such  was  the  practice  of  cold  affusions  as  recommended  by  Dr,  Currie. 
At  present  it  is  but  little  used,,  and  in  place  of  it  the  safer  and  more  con- 
venient mode  of  applying  cold  in  the  form  of  cold  sponging  has  been 
adopted.  Used  in  this  way,  it  proves  exceedingly  salutary  in  allayiug 
morbid  heat,  lowering  the  circulation,  and  soothing  the  patient 

Inflammations. — As  a  general  rule,,  as  has  been  already  stated,  the  use 
of  cold  in  cases  of  internal  inflammations  is  objectionable.  There  are, 
however,  two  exceptions  which  require  especial  notice. 


342  MATERIA  MEDICA   AND  THERAPEUTICS. 

Plirenitis.- — In  cases  of  this  kind,  in  addition  to  venesection,  there  is 
no  remedy  which  exercises  so  powerful  an  influence  as  the  application 
of  cold  to  the  head.  It  may  be  used  in  various  ways — either  by  apply- 
ing cloths  dipped  in  cold  water  to  the  head,  or  by  a  common  bladder 
filled  with  ice,  or  what  is  still  more  efficient,  pouring  cold  water  on  "it 
from  a  vessel.  In  using  this  the  patient  is  to  be  raised  in  bed,  and  the 
body  to  be  protected  from  being  made  wet.  A  large  empty  basin  is  to 
be  held  under  the  chin,  and  the  cold  water  is  then  to  be  poured  from  a 
pitcher  on  the  crown  of  the  head,  the  stream  to  be  raised  gradually  as 
the  patient  can  bear  it.  This  is  to  be  continued  until  the  desired  effect 
is  produced.  This  mode  of  applying  cold  originated,  I  believe,  with  Dr. 
Abercrombie,  of  Edinburgh.  "  Applied  in  this  manner,"  he  says,  "  it 
is  a  remedy  of  such  power  that  it  requires  to  be  used  with  much  discre- 
tion. Under  the  operation  of  it  I  have  seen  a  strong  man  thrown,  in  a 
very  few  minutes,  into  a  state  approaching  asphyxia,  who  immediately 
before  had  been  in  the  highest  state  of  maniacal  excitement,  with  mor- 
bid increase  of  strength,  defeating  every  attempt  of  four  or  five  men  to 
restrain  him."*  The  same  remedy  is  recommended  by  Dr.  Abercrombie 
in  the  convulsive  diseases  of  children,  in  preference  to  the  warm  bath  so 
commonly  used.f 

Gastritis. — There  is  another  form  of  inflammation  in  which  cold  may 
be  used  with  great  advantage,  taken  internally.  Small  pieces  of  ice 
swallowed  have  frequently  an  admirable  effect  in  allaying  the  gastric 
irritation. 

[Intoxication  and  Narcotic  Poisons. — To  remove  the  effects  of 
intoxicating  drinks  no  agent  can  compare  with  cold  affusion.  I  have 
tried  this  very  frequently  on  men  who  were  "  dead  drunk"  unable  to 
move ;  in  ten  minutes  they  walk  about.  It  is,  however,  a  remedy  of 
very  great  power,  and  only  to  be  used  where  there  is  vigor  of  constitu- 
tion. In  poisoning  by  opium,  &c,  it  may  be  relied  on  with  great  confi- 
dence. I  have  again  and  again  seen  persons  profoundly  narcotized 
restored  to  sense  and  life  by  the  continued  use  of  cold  affusion.  It  is,  I 
am  sure,  not  as  frequently  used,  nor  as  confidently  relied  upon  as  it 
should  be. — Ed.] 

*  Abercrombie  on  Brain,  p.  114.  f  P.  175,  also  Tweedie,  p.  146. 


DEMULCENTS 


This  class  of  remedies  was  by  many  supposed  to  act  only  mechani- 
calty,  by  involving  acrid  matters  in  a  mild  and  viscid  coating,  or  by 
sheathing  the  surfaces  to  which  they  were  applied,  and  thus  protecting 
them  from  the  action  of  irritants.  This  is  an  imperfect  view  of  them, 
They  do  in  fact  act  on  the  vital  properties  of  the  system,  diminishing 
tone,  relaxing  and  softening  the  tissues,  and  rendering  them  more  flexi- 
ble. [This  effect  is  probably  owing  to  a  dilution  of  the  blood  by  the 
absorption  of  the  watery  part  of  the  demulcent.] 

Effects. —  On  the  Mucous  System. — When  taken  by  the  mouth, 
emollients,  by  their  bland  influence  on  the  nerves  of  the  mouth, 
pharynx,  oesophagus,  and  stomach,  produce  a  direct  soothing  influence 
on  those  parts,  and  a  like  effect  on  the  bronchial  mucous  membrane. 
Hence  their  use  in  irritations  and  inflammations  of  any  portion  of  the 
gastric  and  pulmonary  membrane.  [Is  it  not  possible  that  demulcents 
may  in  the  same  way  affect  the  vagino-uterine  mucous  membrane,  relax- 
ing its  tissue  and  promoting  secretion  from  it?  If  so,  the  popular 
notion,  that  these  articles  taken  during  the  latter  months  of  gestation 
facilitate  parturition,  may  be  easily  explained.  I  have  generally  attri- 
buted their  effect  (in  the  reality  of  which  I  fully  believe)  to  their  opera- 
tion as  laxatives. — Ed.] 

On  the  Blood  and  the  Hearts  Action. — The  effect  of  demulcents  must 
of  course  depend  here,  if  not  always,  on  the  water  in  which  they  are 
taken :  this  would  impoverish  the  blood  and  thus  lower  the  heart's 
action,  and  diminish  generally  the  tone  of  the  system. 

On  the  Urinary  Organs. — Here  again  these  agents  act  purely  as 
diluents.  They  increase  the  amount  and  diminish  the  acridity  of  the 
urine.  Oil  and  water  are  the  only  essential  emollients.  For  though 
gum,  starch,  sugar,  and  gelatine  are  so  termed,  they  do  not  act  unless 
water  be  present. — Pereira, 


344  MATERIA    MEDICA    AND   THERAPEUTICS. 


INDIVIDUAL    DEMULCENTS. 

GUM    ARABIC. 

This  is  the  product  of  the  Acacia  vera  and  Acacia  nilotica,  native 
trees  of  Africa,  and  found  growing  in  almost  every  part  of  that  conti- 
nent. It  is  a  spontaneous  exudation  from  the  bark  of  the  trunk  and 
branches.  Sometimes  the  exudation  is  promoted  by  artificial  incisions. 
When  it  first  begins  to  flow  it  is  soft  and  almost  liquid,  but  by  exposure 
to  the  air  it  hardens  into  tears.  In  this  form  it  is  imported  from  Barbary 
and  Morocco. 

The  sensible  properties  of  gum  arabic  are  by  no  means  striking.  When 
perfectly  pure  it  is  almost  entirely  destitute  of  color,  or  it  has  a  pale 
yellowish  hue.  It  has  no  smell,  but  a  slightly  sweetish  taste,  and  is 
more  or  less  transparent.  It  is  hard,  brittle,  and  easily  pulverized, 
yielding  a  white  powder.  It  has  all  the  properties  of  pure  gum,  is  com- 
pletely soluble  both  in  cold  and  hot  water,  and  in  this  state  it  forms 
what  is  called  mucilage — when  this  is  evaporated  it  yields  the  gum 
unchanged.  It  is  insoluble  in  alcohol,  ether,  and  the  oils.  By  trituration 
with  the  oils,  volatile  and  fixed,  it  renders  them  miscible  in  water. 

As  sold  in  the  shops,  gum  arabic  is  frequently  mixed  with  gum  Senegal, 
the  product  of  the  Acacia  Senegal,  a  tree  growing  in  the  forests  of  Africa, 
in  the  neighborhood  of  the  Senegal.  In  its  general  properties  this  gum 
does  not  differ  materially  from  the  gum  arabic.  It  comes  in  larger 
pieces  and  is  of  a  reddish  color.  It  is,  however,  nearly  as  pure  as  the 
gum  arabic,  and  in  its  medicinal  properties  is  little  if  at  all  inferior. 

Purity. — Gum  Senegal  is  frequently  substituted  for  gum  arabic.  This 
may  be  distinguished  by  the  gum  Senegal  being  clammy  and  tenacious, 
while  the  gum  arabic  is  dry  and  brittle.  This  is  a  fraud,  however,  of 
no  importance  in  a  medical  point  of  view. 

Sometimes  it  is  mixed  with  the  gum  which  exudes  from  the  plum  and 
cherry  tree.  This  is  much  inferior  to  the  gum  arabic  and  gum  Senegal. 
It  is  distinguished  from  gum  arabic  by  being,  like  tragacanth,  insoluble 
in  water,  whereas  gum  arabic  and  gum  Senegal  are  completely  soluble. 

In  the  form  of  powder  as  sold  in  the  shops,  gum  arabic  is  generally 
adulterated.  The  articles  used  for  this  purpose  are  starch,  wheat,  flour, 
and  sulphate  of  lime. 

Tests. — 1.  Take  a  little  of  the  suspected  article  and  shake  it  in  a  vial, 
with  the  addition  of  cold  water.  The  gum  will  dissolve  in  the  water, 
and  if  there  be  any  of  the  preceding  articles  present,  they  will  fall  to  the 
bottom. 

2.  Boil  the  gum  in  water — add  a  little  nitric  acid  and  then  a  few  drops 


DEMULCENTS.  345 

of  a  solution  of  iodide  of  potassium,     [f  starch  be  present  it  will  striki  a 
blue  color. 

3.  Mix  a  little  of  the  article  with  water  into  a  dough.  Fix  this  to 
the  end  of  a  platinum  wire  and  subject  it  to  the  flame  of  a  blow-pipe. 

If  it  docs  not  burn  away,  but  leaves  anything  behind,  it  is  ;i.d nil  crated. 

4.  If  the  suspected  article  be  mixed  with  the  powder  of  plum  and 
cherry  tree  gum,  it  mates  a  ropy  solution,  Gum  arabic  makes  a  clear 
pellucid  solution. 

Effects. — Gum  arabic  is  one  of  the  most  common  and  best  of  the 
demulcents.  I>y  some  it  is  supposed  to  be  positively  sedative  in  its 
action  upon  irritated  and  inflamed  surfaces.  It  is  also  nutritive, 
although  this  is  positively  denied  by  some.  Experiments  to  ascertain 
this  were  made  by  Magendie  upon  dogs,  who  were  confined  to  the  use 
of  this  article.  In  the  second  week  they  became  emaciated  and  debili- 
tated, and  finally  died  of  marasmus.  In  opposition  to  this,  however, 
there  arc  other  facts  which  show  that  it  cannot  be  so  entirely  destitute 
of  nutritive  properties.  Haselquist,  in  his  "Voyages  in  the  Levant," 
gives  an  interesting  account  of  a  caravan  travelling  from  Ethiopia  to 
Egypt  in  the  year  1750,  which,  during  their  long  journey  across  the 
deserts,  fell  short  of  provisions.  In  searching  among  the  merchandise 
which  they  were  carrying  to  Cairo,  they  fortunately  found  a  quantity  of 
gum  arabic,  and  upon  this  alone  more  than  a  thousand  persons  subsisted 
for  the  space  of  two  whole  months.  Lind  also  states  that  the  srum 
Senegal  or  arabic  serves  as  a  sustenance  for  whole  negro  towns  during 
the  scarcity  of  other  provisions  occasioned  by  a  failure  of  the  crops  of 
millet  and  rice.;  and  the  Arabs  who  twice  a  year  collect  this  gum  in 
the  inland  forests  on  the  north  side  of  the  river  Niger,  have  no  other 
provisions  to  live  upon  for  some  months.  Gum  arabic,  therefore,  may 
be  considered  nutritive  as  well  as  demulcent. 

Mode  of  Administration. — Generally  used  in  the  form  of  solution ; 
one  ounce  of  the  gum  to  a  pint  of  boiling  water  and  suffered  to  cool. 
Also  in  the  form  of  syrup,  by  taking  of  gum  arabic  §  iv,  sugar  g>i,  boil- 
ing water  a  pint.  Dissolve  the  gum  in  the  water;  add  the  sugar  and 
boil  to  the  consistence  of  a  syrup.     Also  in  the  form  of  lozenges. 


TRAGACANTH. 

This  substance  is  obtained  from  different  species  of  Astragalus,  but 
chiefly  from  the  Astragalus  verus.  This  is  a  shrub  growing  two  or 
three  feet  high,  and  is  a  native  of  the  north  of  Persia.  The  gum  exudes 
spontaneously  from  the  stem  and  branches  in  the  heat  of  summer,  and 
is  suffered  to  dry  on  the  plaut  before  it  is  collected.  It  comes  in  small 
wrinkled  pieces  of  a  whitish  color,  without  smell,  and  has  a  slightly 


346  MATERIA   MEDICA  AND  THERAPEUTICS. 

viscid  taste.  Although  considered  as  a  gum,  it  differs  from  this  class  of 
substances  in  the  degree  of  its  solubility  in  water.  When  put  into 
water,  it  imbibes  a  large  quantity  of  that  fluid  and  swells,  but  does  not 
dissolve  nor  form  a  fluid  homogeneous  mixture.  It  is  turbid,  and  on 
standing  separates  from  the  water  and  settles  down.  In  alcohol,  it  is, 
like  gum,  insoluble.  The  principal  peculiarity  of  this  substance  is  the 
power  which  it  possesses  of  giving  viscidity  to  water,  this  being  much 
greater  than  that  of  the  gums.  It  possesses  this  in  a  degree  twenty-four 
times  greater  than  gum  arabic.  It  is  on  this  account  that  it  is  so  much 
used  in  pharmacy  to  give  consistency  to  the  manufacture  of  pills  and 
troches.  "  It  appears  to  be  composed  of  two  different  parts,  one  soluble 
in  water  and  resembling,  though  not  identical  with  gum  arabic ;  the 
other  swelling  in  water  but  not  dissolving."  (U.  S.  Disp.) 

Effects. — Demulcent  and  nutritive,  though  difficult  of  digestion.  In 
consequence  of  its  great  insolubility  not  much  used  internally.  Princi- 
pally used  in  pharmacy. 

LIQUORICE. 

The  plant  which  yields  this  is  the  Glycyrrhiza  glabra,  a  native  of 
Syria,  Barbary,  and  the  south  of  Europe.  It  is  cultivated,  also,  in  all 
parts  of  Europe.  In  the  north  of  Spain  it  is  raised  to  a  great  extent  as 
an  article  of  commerce.  That  which  grows  in  Spain  is  considered  the 
best,  containing  a  larger  proportion  of  saccharine  matter.  The  plant 
grows  about  four  or  five  feet  high.  The  part  used  is  the  root,  which  is 
dug  up  when  the  plant  is  about  three  years  old.  It  is  long  and  flexible, 
and  about  the  size  of  the  little  finger ;  externally  of  a  brownish  color, 
and  yellow  internally.  It  is  without  smell,  and  has  a  sweet,  mucilagi- 
nous taste.  If  chewed  with  the  bark  on,  it  leaves  a  slight  degree  of  bit- 
terness in  the  mouth. 

Composition. — According  to  analysis,  liquorice  contains  glycyrrhizine, 
starch,  asparagin,  resinous  oil,  albumen,  lignin,  and  salts. 

The  glycyrrhizine  is  a  modification  of  saccharine  matter,  scarcely 
soluble  in  cold  water,  but  readily  so  in  boiling  water,  and  differing  also 
from  common  sugar  in  not  being  capable  of  undergoing  fermentation. 
The  resinous  oil  is  bitter,  and  it  is  to  this  the  slight  degree  of  acridity 
which  the  root  possesses  is  owing. 

The  extract  is  prepared  from  the  root  in  the  following  way.  The 
roots,  dried  and  cleaned,  are  cut  .into  small  pieces  and  then  boiled  in 
water  until  the  liquid  is  saturated.  After  the  dregs  have  subsided  it  is 
poured  off  and  evaporated  to  a  proper  consistence,  when  it  is  formed 
into  rolls  about  five  or  six  inches  long  and  an  inch  in  thickness.  These 
are  then  dried  and  covered  with  leaves.  In  this  state  it  is  imported 
from  Spain  and  Italy.     When  pure  it  is  very  black,  dry,  and  brittle, 


DK.MIM'KNTS.  .'J  1  7 

with  :i  glossy  fracture  and  sweetish  taste.     In  water  it  is  completely 

soluble. 

Purity. — Tlic  roots  arc  frequently  worm-eaten  and  decayed.  Those 
are  the  best  which  have  the  brightest  yellow  color  internally  arid  when 
the  layers  are  distinct. 

The  extract  is  very  apt  to  be  adulterated  with  various  articles,  Buch 
as  starch  and  sand.     It  sometimes  also  contains  a  little  copper. 

When  pure  the  extract  ought  not  to  become  moist,  when  cxpo-i  .|  i., 
the  air  in  a  dry  place,  and  it  should  dissolve  in  water  without  having 
any  residue. 

What  is  called  refined  liquorice  is  nothing  more  than  the  foreign 
extract  dissolved  in  water  and  the  solution  filtered  and  inspissated ;  this 
is  usually  then  made  up  into  little  sticks  called  the  pipe  liquorice. 
When  this  is  adulterated  with  starch  it  dissolves  only  partially  in  cold 
water,  and  immediately  deposits  a  dirty  white  powder  possessing  the 
properties  of  starch.  When  mixed  with  carpenter's  glue  it  gives  out 
ammonia,  when  heated  in  a  glass  tube  or  before  a  blowpipe. 

Effects. — Liquorice  is  an  excellent  demulcent  article,  admirably  adapted 
to  allaying  irritations  of  the  mucous  membrane  in  various  parts  of  the 
body.  Hence  it  has  been  used  with  great  advantage  in  catarrhal  affec- 
tions, and  irritations  of  the  urinary  organs. 

Of  the  root  the  best  preparation  is  the  decoction,  made  by  boiling  ?  j 
of  the  root  in  a  pint  of  water  for  about  ten  minutes.  As  the  bark  is 
acrid,  this  should  be  taken  off  before  it  is  boiled. 

The  extract  may  be  taken  either  in  the  solid  form  or  in  solution,  or  in 
the  form  of  lozenges. 


marsh  mallows  (Althaia  officinalis). 

This  is  a  plant  growing  in  Europe,  on  banks  of  rivers,  and  in  marshy 
places,  from  which  circumstance  it  derives  its  name.  It  grows  to  the 
height  of  four  or  five  feet,  and  the  part  used  is  the  root.  When  prepared 
for  the  market  the  epidermis  is  taken  off.  It  is  of  a  whitish  color, 
destitute  of  smell,  and  has  a  viscous  mucilaginous  taste.  Every  part  of 
the  plant  abounds  in  mucilage  and  starch,  besides  sugar.  It  also  con- 
tains a  peculiar  principle  which  has  been  called  althein,  but  which  is 
identical  with  asparagin. 

Effects. — An  excellent  emollient  and  demulcent,  and  in  general  use  as 
such  in  France  and  Europe  generally. 

It  is  used  in  the  form  of  decoction  and  syrup.  In  this  country  it  is 
not  much  used,  being  considered  inferior  to  gum  arabic. 


23 


348  MATERIA   MEDICA   AND  THERAPEUTICS. 


jujube  (Rhamnus  zizypfaas). 

The  tree  yielding  the  jujube  is  cultivated  in  the  south  of  France,  in 
Spain,  and  in  Italy.  The  part  used  is  the  fruit.  This  is  of  an  .oval 
shape,  about  the  size  of  an  olive,  and  of  a  reddish  color.  Internally  it 
contains  a  yellowish  mucilaginous  pulp,  with  a  sweetish  and  acidulous 
taste.  It  is  demulcent  and  nutritive.  If  taken  to  any  extent  it  proves 
laxative.     It  is  used  in  the  form  of  decoction. 

The  jujube  paste,  which  is  so  commonly  sold  in  the  shops,  should 
consist  of  gum  arabic  and  sugar,  dissolved  in  a  decoction  of  this  fruit 
and  evaporated  to  a  proper  consistence.  The  preparation,  however, 
very  seldom  contains  any  of  the  jujube.  [Would  probably  be  no  better 
if  it  did.] 

slippery  elm  bark  {Ulmus  fu'lva,  the  red  elm  or  slippery  vim). 

It  is  a  lofty  tree,  growing  to  the  height  of  50  or  60  feet,  and  is  indi- 
genous in  this  country,  more  particularly  in  the  Northern  and  Western 
States. 

The  part  used  in  medicine  is  the  inner  bark,  from  which  the  epider- 
mis has  been  removed.  It  comes  in  long  flat  pieces  of  a  fibrous  texture, 
with  a  sweetish  and  mucilaginous  taste  when  chewed. 

It  contains  fecula,  yum,  and  ulmin.  It  abounds  in  mucilaginous 
matter,  and  by  infusion  or  gentle  boiling  in  water  it  is  readily  dissolved 
and  forms  an  insipid  mucilaginous  fluid. 

Effects. — The  substance  is  highly  demulcent  and  nutritive.  In  times 
of  scarcity  the  Indians  are  said  to  live  upon  it.  Another  use  made  by 
them  of  it  is  to  facilitate  labor.  According  to  Mr.  Rafinesque,  it  is  "  a 
specific  to  procure  easy  labor  to  pregnant  women  by  using  the  tea  for 
two  months  previous,  well  known  to  Indian  women,  whose  easy  partu- 
rition has  often  been  noticed."  Med.  Flor.  vol.  ii.  p.  271.  It  is  also 
somewhat  diuretic. 

Mode  of  Administration. — The  common  form  is  that  of  infusion  made 
by  macerating  an  ounce  of  'the  bark  in  a  pint  of  cold  water.  When 
ground  into  powder  it  makes  a  kind  of  flour,  which  mixed  with  boiling 
water  makes  a  mucilage.  [The  cold  infusion  of  the  unground  bark  is 
much  more  palatable.]     It  makes  an  agreeable  demulcent  drink. 

The  powder  made  into  a  poultice  is  an  admirable  local  application. 


The  Sesamum  orientale,  a  native  of  the   East   Indies    and  Africa. 
From  the  latter  region  it  was  introduced  by  the  negroes  into  the  West 


DKMULOKWTS.  349 

Indies  and  tlie  Southern  States',  especially  Georgia  and  South  Carolina, 
where  it  succeeds  very  well.  In  this  latitude  it  grows  very  well,  but 
never  comes  to  seed.  Tt  is  an  -animal  plant,  about  three  or  four  feet 
high,  and  yields  a  small,  yellowish  seed,  which  is  particularly    trainable 

for  the  quantity  and  quality  of  the  oil  which  is  obtained  from  it.     Ii 
said  that  by  expression  ninety  per  cent,  of  this  oil  is  obtained  from  the 

seeds,  a  larger  proportion  than  that  yielded  by  any  other  known  vege- 
table, and  of  a  quality  fully  equal  to  the  common  olive  oil.  liy  the 
negroes  the  seeds  are  used  as  an  article  of  food,  boiling  them  with 
Indian  corn,  &c. 

The  oil  is  without  smell,  of  a  sweetish  taste,  and  can  be  kept  a  long 
time  without  becoming  rancid.  In  China  and  Japan  it  is  used  in  cook- 
ing and  as  an  article  of  food.  Its  properties  are  very  analogous  to 
olive  oil,  and  like  that  in  suitable  quantities  prove  laxative. 

The  part  used  in  medicine  is  the  leaves.  These  abound  in  mucilagi- 
nous matter,  which  is  readily  imparted  to  water. 

Effects. — Emollient  and  nutritive.  The  oil  is  laxative,  and  is  some- 
times used  as  a  substitute  for  castor  oil. 

Mode  of  Administration. — One  or  two  of  the  fresh  leaves  stirred  in 
half  a  pint  of  cold  water  in  a  short  time  form  a  thick  viscid  mucilage, 
which  is  used  with  much  advantage  in  bowel  affections,  particularly  of 
children.  It  may  be  drunk  freely.  When  the  leaves  are  dried  boiling 
water  is  required. 


FLAXSEED. 

This  is  furnished  by  the  Linum  usitatissimum,  a  well  known  plant, 
supposed  to  have  come  originally  from  Egypt,  but  now  found  in  almost  all 
parts  of  the  world.  It  grows  about  two  feet  high.  The  part  used  in 
medicine  is  the  seeds.  These  have  a  mucilaginous  and  somewhat 
sweetish  taste,  and  are  destitute  of  smell.  They  consist  chiefly  of  muci- 
lage, of  which  they  contain  a  large  proportion,  and  a  fixed  oil  (linseed 
oil) ;  the  former  residing  in  the  cuticle,  and  the  latter  in  the  nucleus  or 
parenchymatous  portion  of  the  seeds.  The  oil  is  obtained  by  expres- 
sion from  the  seeds  in  the  proportion  of  about  one  sixth  of  their  weight. 
The  cake  which  remains  after  the  expression  of  the  oil,  is  ground  up 
and  makes  the  -linseed  meal.  As  this  contains  all  the  mucilaginous 
part  of  the  seed,  it  is  highly  nutritive  and  is  used  as  food  for  cattle. 

Effects. — Flaxseed  is  emollient  and  demulcent,  and  is  also  nutritive. 

The  seeds,  reduced  by  means  of  a  mill  to  a  soft  farina,  are  used  in 
many  parts  of  Asia,  as  an  article  of  food,  mixed  with  honey.  At  Lace- 
demon  it  is  said  to  have  been  used  as  food  for  the  Helots.  In  times  of 
famine  in  Holland  it  has  served  as  sustenance,  and  it  is  stated  that  the 


350  MATERIA   MEDICA   AND   THERAPEUTICS. 

French  soldiers  in  their  retreat  from  Moscow  fed  upon  the  cataplasms 
of  this  substance  previously  used  for  the  sick. 

Linseed  oil  is  laxative. 

Mode  of  Administration. — The  ordinary  form  of  using  it  is  the 
infusion,  made  by  digesting  §  i  of  the  seeds  in  two  pints  of  boiling 
water.  The  hot  water  extracts  the  mucilage  from  the  cuticle  without 
any  of  the  oily  matter.  To  make  it  more  agreeable  3  j  or  3  ij  of  braised 
liquorice  root  is  added,  [or  a  little  lemon  juice.] 

The  meal  is  used  for  making  poultices.  The  principal  use  of  the  oil 
is  as  a  local  application  to  burns,  mixed  with  lime  water. 


This  is  the  product  of  the  Hordeum  distickon,  a  native  of  Tartary, 
but  cultivated  in  different  parts  of  the  world.  The  parts  used  are  the 
seeds  or  grains.  When  the  seeds  are  deprived  of  their  husks,  they  are 
called  hulled  barley ;  when  deprived  of  their  husks,  and  afterwards 
rounded  and  polished,  which  is  done  in  a  mill,  they  are  called  pearl 
barley ;  when  the  pearl  barley  is  ground  into  a  meal,  it  is  patent 
barley. 

Barley  contains  a  large  proportion  of  starch — 67  in  100  parts. 
Besides  this,  sugar,  gum,  gluten,  albumen,  &e. 

Effects. — Highly  demulcent  and  nutritious.  The  husk  is  slightly 
acrid  and  laxative.     The  pearl  barley,  therefore,  ought  to  be  used. 

Form. — The  usual  form  is  that  of  decoction,  or,  as  it  is  called,  barley 
water.  The  mode  of  preparing  this  is  important,  and  it  is  directed  in 
the  Pharmacopoeia.  Take  two  ounces  of  pearl  barley,  and  wash  with 
cold  water,  so  as  to  cleau  it  well,  then  pour  on  half  a  pint  of  water  and 
boil  for  a  little  time,  and  throw  away  this  water.  The  object  of  this  is 
to  purify  it  still  more,  and  remove  any  mustiness  or  other  unpleasant 
flavor  'which  it  may  have  acquired.  Then  add  four  pints  of  boiling 
water,  and  boil  down  to  two  pints  and  strain.  This  may  be  flavored 
with  sugar,  lemon,  &c. 


This  is  obtained  from  the  Avena  sativa,  a  plant  cultivated  in  every 
part  of  the  world.  The  seeds,  when  deprived  of  their  husks,  are  called 
groats ;  then  when  crushed  are  called  Emden  groats.  (Pereira.)  By 
simply  grinding  the  seeds,  the  oatmeal  is  obtained. 

According  to  the  analysis  of  Vogel,  100  parts  of  oatmeal  contain  59 
of  starch,  8.25  sugar,  2.50  gum,  2  fixed  oil,  4.30  albuminous  matter, 
23.95  fibrous  matter. 


m.Yil    I.-    I.N-I.-,. 


361 


Dr.  Christison  makes  seventy-two  per  cent,  of  stareh. 
Effects. — Oatmeal  in  the  form  of  gruel  is  emollient,  and  nutrition  ,    I' 
proves  somewhat  laxative. 

Oatmeal  gruel  is  prepared  by  boiling  one  ounce  of  the  meal  with  thre 
pints  of  water  to  a  quart,  constantly  Btirring  it.     Then  Btrain;   lei 
stand  till  it  cook,  and  then  pour   off  the  clear  liquor  from  the  Bedi- 
ment.     It  may  be   flavored    with    sugar,  lemon   juice,  &c.     It  ia  fre- 
quently used  after  giving  cathartios,  also  for  encmata.    The  meal  make« 
an  excellent  poultice. 


INDIAN    MEAL. 


This  is  obtained  from  the  Zea  Mays,  Maize,  or  Indian  Com.     Tin 
contains  seventy-seven  per  cent,  of  starch,  but  no  glutei:.     It  is  demul- 
cent, and  highly  nutritive.     In  the  form  of  gruel  it  is  used  as  a  sub  ■ 
tute  for  oatmeal. 


This  is  the  Oryza  sativa,  an  annual  plant  coming  originally  from  the 
East  Indies,  but  now  cultivated  in  various  parts  of  the  world.  The  rice 
of  commerce  consists  of  the  seeds  deprived  of  the  husk. 

According  to  Braconnot,  it  contains  in  100  parts  85.07  starch,  3.60 
gluten,  0.71  gum,  0.29  sugar,  0.13  fixed  oil,  4.80  vegetable  fibre.,  5.00 
water,  0.40  saline  substance. 

Effects. — Demulcent  and  highly  nutritive.  It  sits  easy  on  the  stomach, 
and  from  the  fact  that  after  its  digestion  a  very  little  residuum  is  left,  it 
is  considered  astringent  to  the  bowels.  In  the  form  of  rice  water,  it  is 
an  excellent  drink  in  irritation  of  the  bowels  with  diarrhoea,  <fcc.  This 
is  made  by  boiling  two  ounces  of  rice  in  two  quarts  of  water  for  about 
an  hour  and  a  half     To  this  sugar  may  sometimes  be  added 


ARROW-ROOT. 

The  plant  which  yields  this  is  the  Maranta  arundinacea,  a  native  of 
South  America  and  the  West  Indies.  It  is  also  cultivated  in  the  East- 
Indies,  in  Florida,  and  the  southern  parts  of  the  United  States.  It  is 
perennial,  growing  two  or  three  feet  high.  It  derives  its  name  from 
the  fact  of  the  native  Indians  applying  the  mashed  root  to  the  wounds 
of  their  arrows.  The  part  used  is  the  root:  this  is  tuberous  and  fleshy, 
and  from  six  to  twelve  inches  in  length.  The  mode  of  obtaining  the 
arrow-root  is  the  following. 

The  tuberous  roots  are  dug  up  when  about  a  year  old,  washed,  and 
then  beaten  in  wooden  mortars  to  a  pulp.     This  is  then  thrown  into 


352  MATERIA  HEDICA   AND  THERAPEUTICS, 

water  and  well  stirred,  for  the  purpose  of  separating  the  amylaceous 
from  the  fibrous  part.  The  fibrous  part  is  next  wrung  out  by  the  hand 
and  removed.  The  milky  liquor  which  remains  is  then  strained  through 
linen,  which,  on  standing,  deposits  a  white  mass.  The  water  is  drained 
off, -and  the  mass  again  mixed  with  clean  water  and  drained. 

The  mass  which  remains  is  then  dried  on  large  sheets  in  the  sun. 
This  is  the  arrow-root  of  commerce.  It  is  in  the  form  of  a  white 
powder  or  small  granular  masses,  producing  a  slight  crackling  noise 
when  rubbed  between  the  fingers.  It  is  without  smell  or  taste.  Exa- 
mined by  the  microscope,  it  consists  of  oblong  or  irregularly-shaped  con- 
vex particles,  with  small  mamillary  processes  upon  the  surface.  Under 
the  action  of  boiling  water  it  forms  a  jelly,  and  this  is  the  state  in  which 
it  is  used. 

Arrow-root  is  a  pure  starch,  similar  in  its  chemical  constitution  to 
wheat  starch. 

Purity. — Arrow-root  is  frequently  adulterated  with  wheat  and  potato 
starch.  Although  in  a  medicinal  point  of  view  there  is  little  difference 
between  these  articles,  yet  it  is  important  to  be  able  to  .detect  the  fraud. 

"  Arrow-root  is  not  so  white  as  the  two  other  kinds  of  starch,  but  its 
grains  are  much  finer,  and  when  examined  by  a  magnifying  glass,  appear 
pearly  and  very  brilliant.  Moreover,  true  arrow-root  always  contains  a 
great  number  of  little  clots,  which  are  formed  by  the  aggregation  of  the 
minute  grains  during  the  operation  of  drying.  These  clot3  crumble  with 
ease  when  bruised  with  the  fingers.  Finally,  the  jelly  which  arrow-root 
produces  with  water  has  no  odor,  while  the  jellies  which  are  formed  by 
wheat  or  potato  starch  are  characterized  by  an  odor  at;  once  powerful 
and  peculiar." 

Effects. — This  is  an  excellent  demulcent.  In  this  quality  it  is  sup- 
posed to  excel  all  the  other  feculse.  It  is  also  nutritious,- and  constitutes- 
an  excellent  article  of  diet  in  certain  eases.  [The  nutritive  power  of 
arrow-root  is  much  exaggerated  by  popular  prejudice.  It  is  as  food  for 
infants  a  very  poor  substitute  for  milk. — C.  R,  G.] 

The  ordinary  mode  of  preparing  it  for  use  is  first  to  make  a  paste  of 
the  powder,  with  cold  water,  and  then  adding  boiling  milk  or  waterr 
and  stirring  briskly.  In  this  way  it  speedily  forms  a  clear  jelly,  which,, 
according  to  the  circumstances  of  the  case,  may  be  qualified  with  sugar, 
lemon  juice,  or  wine.  A  tablespoonful  of  the  powder  will  answer  for  a 
pint  of  water. 


This  is  the  product  of  the  Cycas  circinalis,  a  species  of  palm  tree  very 
abundant  in  the  East  Indies.  It  grows  to  the  height  of  twenty  or  thirty 
feet,  and  the  trunk  contains  a  large  quantity  of  spongy  medullary  mat- 


DEMULCENTS.  358 

tcr.  It  is  from  this  that  the  sago  is  obtained.  At  a  proper  eason,  the 
tree  is  cut  down  and  divided  into  pieces  and  split.  The  medullary  mat- 
ter is  taken  out  and  reduced,  by  beating,  to  a  powder.  Thi  i  mixed 
with  water  and  afterwards  strained  through  a  sieve.  On  standing  the 
fecula  subsides  and  the  water  is  separated.  It  is  dried  in  the  form  of 
meal,  or  made  into  cakes.  This  is  the  form  in  which  it  is  used  by  the 
natives.  For  exportation  the  meal  is  made  into  a  paste  with  water  and 
then  rubbed  into  grains.  By  the  Chinese  of  Malacca,  it  is  prepare']  so 
as  to  give-  the  grains  a  pearly  appearance.  This  is  what  is  called  the 
pearl  sago.  A  single  tree  is  said  to  furnish  five  or  six  hundred  pounds 
of  sago. 

Pearl  sago  comes  in  small  hard  grains,  about  the  size  of  a  pin's  head, 
of  a  pinkish  color,  without  smell  and  very  little  taste. 

In  its  chemical  composition  it  is  analogous  to  starch.  In  cold  water 
it  is  insoluble.  In  boiling  water,  it  is  soluble,  but  less  so  than  other 
fecula).  If  the  grains  be  put  into  boiling  water,  they  become  soft  and 
swell,  still,  however,  retaining  their  form.  It  makes  a  perfect  jelly  only 
when  the  grains  have  been  previously  pulverized. 

Effects. — Sago  is  not  used  except  as  food.  If  properly  prepared,  it 
forms  a  light,  excellent  article  during  convalescence,  and  in  cases  where 
you  wish  to  give  some  support  to  the  system  without  the  stimulating 
effects  of  stronger  food.  The  proper  mode  of  preparing  it  is  to  boil  it 
thoroughly  in  water  or  milk.  Then  strain  it  so  as  to  separate  the  grains 
which  may  be  undissolved,  and  to  this  may  be  added  sugar,  nutmeg, 
and  wine,  according  to  circumstances.  A  tablespoonful  will  answer 
for  a  pint  of  water. 

TAPIOCA    OR    CASSAVA. 

This  is  another  fecula  analogous  to  the  two  preceding.  It  is  yielded 
by  the  Jatropa  Manihot,  a  tree  generally  supposed  to  be  a  native  of 
South  America,  but  according  to  Abbe  Raynal,  brought  originally  from 
Africa  by  the  negroes.  According  to  Anslie,  it  also  grows  in  many 
parts  of  India,  and  from  it  tapioca  was  obtained  by  him.  It  is  cultivated 
extensively  in  Brazil  and  the  West  Indies.  Tapioca  is  obtained  from 
the  root  of  the  plant.  This  is  first  washed  and  scraped  or  ground  into 
a  pulp,  which  is  then  subjected  to  pressure  to  separate  the  juice.  This 
juice,  on  standing,  deposits  a  powder,  which,  after  washing  with  cold 
water,  is  nearly  pure  fecula.  This,  when  dried  without  heat,  is  in  the 
form  of  a  powder  and  resembles  arrow-root ;  when  dried  on  heated 
plates,  it  assumes  the  granular  form  in  which  we  have  it. 

The  compressed  pulp  is  dried  and  ground,  and  forms  a  kind  of  meal, 
which  is  called  cassava  meal ;  from  this  the  cassava  bread  is  made,  which 
is  eaten  by  the  negroes. 


354  MATERIA   MEDICA   AND   THERAPEUTICS. 

The  root  consists  chiefly  of  starch  and  a  white  milky  %)oisonous  juice. 
If  eaten  in  the  raw  state  the  root  is  highly  poisonous.  By  the  processes 
just  described  this  is  separated.  As  the  poisonous  principle  is  volatile, 
what  remains  of  it  in  the  meal  is  dissipated  by  heat. 

Tapioca  comes  generally  in  the  form  of  hard,  white,  irregular  grains, 
sometimes  in  the  form  of  powder.  It  is  called  Brazilian  arrow-root. 
It  has  a  slightly  sweetish  taste.  In  cold  water  it  is  only  partially  solu- 
ble. In  boiling  water  it  readily  forms  a  jelly,  which  is  inodorous,  trans- 
parent, and  insipid. 

Purity. — An  artificial  tapioca  is  made  from  wheat  and  potato  starch. 
When  heated  with  boiling  water  this  makes  a  jelly,  which  is  opaque,  and 
has  the  peculiar  odor  of  wheat  and  potato  starch. 

Effects. — Demulcent  and  nutritious,  resembling  in  their  properties 
arrow-root  and  sago.  Prepared  with  boiling  water  it  forms  a  jelly,  and 
in  this  way  is  used  like  the  preceding  articles  as  an  article  of  food,  with 
the  addition  of  sugar,  lemon  juice,  &c. 


SALEP. 

This  is  obtained  from  the  Orchis  mascula,  and  other  species  of  the 
same  genus.  It  grows  in  various  parts  of  Europe  and  Asia.  In  the 
East  it  is  extensively  cultivated,  and  is  very  much  used  as  an  article  of 
diet  by  the  inhabitants  of  Turkey,  Persia,  and  Syria.  The  part  used  is 
the  root.  This  consists  of  two  bulbs  of  an  oval  shape  and  white  color. 
They  are  prepared  for  use  by  rubbing  off  the  epidermis,  putting  them  in 
hot  water  and  then  drying  them. 

Salep  comes  in  small,  oval,  irregular  masses  of  yellowish  color  and 
horny  consistence.  They  have  a  mild,  mucilaginous  taste,  with  a  slight 
odor.     Sometimes  it  comes  in  the  state  of  powder. 

Purity. — In  the  state  of  powder  it  is  very  apt  to  be  adulterated  with 
a  factitious  salep  made  from  potatoes.  These  are  peeled,  cut  into  slices, 
baked  until  they  become  brittle,  and  then  ground  into  powder. 

Effects. — Demulcent  and  nutritive.  It  is  supposed  to  contain  a  greater 
quantity  of  vegetable  nourishment  in  a  smaller  compass  than  any  other 
substance.  It  has  accordingly  been  recommended  as  a  valuable  article 
for  long  voyages,  &c. 


NAECOTTCS 


The  term  Narcotic  literally  means  an  agent  which  possesses  the  power 
of  producing  torpor  and  insensibility.  Various  other  terms  have  been 
applied  to  the  articles  usually  ranged  under  this  class.  They  have  been 
called  Sedatives,  from  their  repressing  action — Anodyne*,  from  their 
relieving  pain — Hypnotic*  and  Soporific*,  from  tlieir  inducing  A<  >-\<. 
Of  all  these  the  term  narcotic  is  the  best,  as  being  the  most  general  and 
descriptive.  They  may  be  defined  to  be  those  substances  "  which  first 
excite  and  then  diminish  nervous  action,  and  in  appropriate  doses  stupe- 
fy." They  are  distinguished  from  all  other  agents  by  the  primary  and 
special  influence  which  they  exert  over  the  brain  and  nervous  system. 

Effects. — As  the  effects  of  these  agents  will  be  fully  exemplified  when 
we  come  to  treat  of  opium,  the  present  description  will  be  purposely 
brief.  There  is  no  class  of  agents  which  differ  more  fn  their  effects 
according  to  the  dose  in  which  they  are  taken.  In  very  small  doses, 
they  appear  to  exert  scarcely  any  action  except  a  local  one,  diminishing 
the  sensibility  and  irritability  of  the  part  with  which  they  come  in  con- 
tact. When  given  in  larger  doses,  their  first  effect  is  to  excite  the 
nervous  and  vascular  systems.  The  energy  of  the  brain  is  increased, 
and  the  pulse  is  moderately  quickened.  This  effect  takes  place  in  a  few 
minutes  after  the  administration  of  the  narcotic.  After  a  short  time  a 
state  of  diminished  sensibility  succeeds.  The  influence  of  external 
agents  is  lessened,  the  pulse  becomes  slower,  and  a  general  languor 
overcomes  the  system.  Then  follow  insensibility  and  sleep.  With 
regard  to  the  power  of  producing  sleep,  it  is  to  be  observed  that  all 
narcotics  do  not  possess  it  equally.  Some  have  it  in  an  eminent  degree, 
while  others,  if  they  possess  it  at  all,  do  it  only  by  the  relief  which  they 
afford  from  pain  and  irritation.  On  the  digestive  organs  the  effect  of 
narcotics  is  to  impair  the  tone  of  the  stomach,  diminish  secretion,  lessen 
the  appetite,  and  to  interfere  with  the  process  of  digestion.  On  the 
intestines  they  differ  in  their  operation.  Some,  opium  for  example,  con- 
stipate, while  others,  hyoscyamus,  stramonium,  and  the  hop,  relax  the 
bowels. 

In  very  large  doses,  narcotics  prove  poisonous,  and  to  the  state  of  the 
system  which  is  induced,  the  general  term  of  narcotism  is  applied.     This 


356  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

state  is  characterized  by  a  perverted  and  prostrated  condition  of  the 
brain  and  nervous  system.  It  comes  on  with  giddiness  and  heaviness 
of  the  head.  The  energy  of  the  brain  being  impaired,  that  organ  loses 
its  controlling  power  over  the  rest  of  the  system.  The  senses  are  per- 
verted. The  mind  loses  its  power — stupor  or  delirium  supervenes.  The 
muscles  are  relaxed  or  convulsively  agitated.  Finally  deep  sleep 
benumbs  the  whole  system,  succeeded  by  coma  and  death. 

With  regard  to  the  effect  of  narcotics  there  are  two  or  three  modify- 
ing circumstances  of  importance  which  ought  to  be  borne  in  mind. 
These  are  the  age  of  the  subject,  the  fact  of  the  system  being  accustomed 
to  their  use  or  not,  and  the  actual  condition  of  the  system  as  to  health 
or  disease. 

Age. — From  the  great  delicacy  and  susceptibility  of  the  nervous 
system  in  children,  the  impression  made  by  narcotics  is  proportionately 
much  greater  in  them  than  in  adults.  Unpleasant  effects,  therefore,  not 
unfrequcntly  occur  in  them  from  the  smallest  quantities.  In  early  life, 
therefore,  narcotics  are  to  be  looked  upon  as  uncertain  agents,  and  to  be 
administered  with  great  circumspection,  especially  as  it  regards  the 
dose. 

[This  is  a  caution  which  cannot  be  too  often  repeated. — Ed.] 

The  repeated  or  habitual  use  of  these  agents  has  a  wonderful  influence 
in  modifying  their  effects ;  and  the  general  law  of  the  system  in  relation 
to  them  is,  that  repetition  of  them  gradually  impairs  their  effects.  Larger 
doses,  therefore,  can  be  continually  borne,  and  to  produce  the  same  effect 
larger  quantities  are  required  to  be  given.  This  is  remarkably  the  case 
with  opium.  It  does  not  follow  from  this,  however,  that  when  the 
system  has  become  habituated  to  one  narcotic,  it  is  so  to  all  others.  The 
contrary,  indeed,  is  the  fact.  A  person,  for  example,  who  has  become 
accustomed  to  large  doses  of  opium,  may  still  be  affected  by  moderate 
doses  of  other  narcotics. 

The  actual  state  of  the  system  as  to  disease  greatly  modifies  the  effect. 

In  certain  diseased  conditions,  immense  quantities  of  opium  and  other 
narcotics  can  be  given  with  perfect  impunity  ;  nay,  with  benefit ;  quan- 
tities which,  in  the  ordinary  state  of  the  system,  would  inevitably 
prove  fatal. 

There  are  certain  conditions  of  the  system  in  which  the  use  of  nar- 
cotics is  contra-indicated.  From  the  primary  stimulant  operation  which 
they  produce,  as  well  as  from  the  determination  which  they  cause  to  the 
brain,  they  are  not  advisable  where  great  plethora  exists,  or  where 
inflammation  or  active  determination  to  the  brain  is  present.  For  the 
same  reason,  where  high  inflammatory  or  febrile  action  is  present,  and 
the  bowels  are  costive,  they  are  contra-indicated.  In  all  these  cases,  if 
their  use  be  deemed  necessary,  it  should  be  preceded  by  depletion  and 
evacuants. 


NARCOTICS.  357 

The  uses  to  which  narcotics  are  applied  in  the  treatment  ol 
are  various  and  important.     They  arc  used  : 

To  make  a  powerful    impression  on  the  nervous  system,  with  I  lie  view 

of  breaking  up  morbid  action.     For  this  purpose  they  are  resorted  to  in 
diseases  characterized  by  paroxysms,  and  in  intermission  . 

They   are  used   to   procure  sleep,   to   allay   gain   or   irritability  of  tin 
system  depending  upon  exhaustion,  to  control  spasm,  to  restrain  exc 

sive  secretions,  and  to  repress  convulsive  reaction. 


It  is  the  inspissated  juice  of  Papaver  somniferum,  or  white  poppy,  a 
plant  which  is  a  native  of  Asia,  and  from  the  fact  of  its  growing  wild  in 
the  southern  parts  of  Europe,  it  is  supposed  to  have  been  native  there 
also.  The  probability,  however,  is  that  the  seeds  of  it  were  conveyed 
to  these  regions  from  Asia.  In  Greece  the  poppy  was  cultivated  at  a 
very  early  period,  long  indeed  before  the  time  of  Hippocrates.  It  is 
alluded  to  by  Homer  in  the  Iliad,  and  the  Roman  historian  Livy  gives 
a  notice  of  it  as  cultivated  in  the  gardens  of  Tarquin  the  Proud.  It 
was  not,  however,  for  the  purpose  of  obtaining  what  is  now  called 
opium  that  this  plant  was  so  much  cultivated  by  the  ancients,  nor  was 
it  used  at  that  early  day  as  a  medicine.  Strange  as  it  may  appear  to 
us,  it  was  cultivated  entirely  as  an  article  of  food,  and  the  part  used 
was  the  seeds,  which  were  considered  as  not  merely  destitute  of  all 
noxious  and  narcotic  properties,  but  exceedingly  nutritious.  In  such 
honor  was  the  poppy  held,  that  its  discovery  was  attributed  to  the  god- 
dess Ceres,  and  from  this  circumstance  she  was  named  Mecone  (from 
fj,*jxwv,  papaver).  It  was  offered  to  her  in  her  sacred  rites,  and  she  was 
represented  as  holding  it  in  her  hand.-  It  can  hardly  be  supposed  that 
so  much  importance  would  have  been  attached  to  the  poppy,  unless  it 
had  been  looked  upon  as  a  very  valuable  article  of  food.  That  there  is 
nothing  noxious  in  the  seed  of  this  plant  has  been  proved  by  modern 
observations.  Dr.  Allston  states  that  he  frequently  ate  large  quantities 
of  the  black  as  well  as  the  white  seed  ;  that  he  found  them  of  a  more 
delicious  taste  than  sweet  almonds ;  that  they  are  oily  and  farinaceous, 
and  he  never  found  them  to  produce  any  injurious  or  soporific  effects. 
Besides,  they  are  still  used  as  food  in  some  places  as  well  as  the  ex- 
pressed oil,  which  is  as  innocent  and  wholesome  as  olive  oil.  In  Per- 
sia, it  is  stated  that,  even  at  the  present  day,  where  the  plants  spring- 
up  too  thickly  in  the  fields  in  which  they  are  sown,  the  young  ones  are 
taken  up  and  used  as  pot  herbs.  That  the  modern  poppy  plant  is 
identically  the  same  as  that  which  was  known  among  the  ancients,  is 
abundantly  shown  from  the  descriptions  left  by  Dioscorides  and  Theo- 
phrastus. 


358  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

When  opium,  as  now  used,  was  first  known,  is  a  matter  of  uncer- 
tainty. By  some  medical  antiquarians  it  is  traced  as  far  back  as  the 
time  of  Homer,  and  it  is  contended  that  what  he  describes  under  the 
name  of  vsirsvfag,  was  nothing  more  nor  less  than  opium.  Against  the 
supposition,  however,  of  this  being  opium,  it  is  urged  that  neither  Theo- 
phrastus  nor  Plinjr,  nor  any  of  the  ancients,  who  mention  the  nepenthes, 
took  it  for  opium ;  and  further,  that  the  Egyptian,  Arabian,  Persian, 
and  Indian  names  of  opium  are  evidently  from  the  Greek  word  otfiov,  as 
ofium,  aufian,  ofium,  afiuum,  &c.  Dr.  Allston  thinks  it  most  probable 
that  the  discovery  of  the  soporific  property  of  opium  is  due  to  the 
Greeks,  and  that  it  was  first  ascertained  by  Hippocrates,  or  at  any  rate 
about  the  period  in  which  he  lived.  It  does  not  appear,  however,  to 
have  been  prescribed  with  this  view  in  medicine  until  two  or  three 
hundred  years  after  this. 

Although  a  native  of  Asia,  the  poppy  is  not  confined  to  any  particu- 
lar country  or  latitude.  It  easily  accommodates  itself  to  different  de- 
grees of  temperature,  and  is  found  flourishing  in  different  parts  of  the 
world.  In  Hindostan,  Persia,  Asia  Minor,  and  Egypt,  it  is  extensively 
cultivated  for  the  opium  which  it  yields.  In  Europe  it  is  cultivated 
principally  for  the  poppy  seeds  and  the  oil.  In  different  parts  of  the 
United  States  it  has  been  reared  with  success,  and  good  opium  pro- 
cured from  it. 

Although  it  thus  appears  that  the  poppy  flourishes  very  well  in  dif- 
ferent regions  of  the  world,  yet,  like  many  other  plants,  it  is  consider- 
ably modified  by  situation,  soil,  and  climate,  and  from  the  same  causes 
the  opium  which  it  yields  varies  in  its  powers.  "  Egypt"  is  said  to 
produce  "  a  stronger  opium  than  any  of  the  countries  on  the  north  side 
of  the  Mediterranean  ;  France,  than  England  or  Germany ;  and  Lan- 
guedoc,  than  the  northern  parts  of  France ;  while  Smyrna,  Anatolia, 
Aleppo,  and  Apulia  furnish  a  juice  far  more  narcotic  than  Languedoc." 
(Paris,  p.  58.)  By  some  the  opium  raised  in  England  is  pronounced 
superior  to  the  Turkey  or  East  India  opium.  If  it  is  so,  it  is  probably 
owing  to  the  greater  care  with  which  it  is  prepared.  In  the  southern 
parts  of  the  United  States  there  is  no  doubt  that  opium  might  be  ob- 
tained equal  to  any  in  the  world,  and  it  might  be  an  object  worthy  of 
some  of  the  enterprising  capitalists  of  our  country  to  make  the  attempt. 

The  poppy  is  an  annual  plant.  In  India,  where  it  attains  a  much 
larger  size  than  it  does  in  any  other  part  of  the  world,  it  flowers  in  the 
month  of  February.     In  Europe  and  America,  in  June  and  July. 

The  greatest  height  to  which  it  attains  in  situations  favorable  to  its 
growth,  is  from  five  to  six  feet.  Every  part  of  it  contains  a  narcotic 
juice,  but  it  abounds  most  in  the  cajisules,  and  from  them  the  opium  is 
obtained. 

The  mode  of  procuring  it,  as  practised  in  India,  is   the  following : 


NASCOTICS.  369 

When  the  large  capsules  are  about  half  ripe,  longitudinal  inci 

made  on  their  Bides,  just  deep  enough  to  divide  the  i  sternal  part  with- 

out  penetrating  the  internal  cavities.    This  operation  is  performed  in 

the  evening.  During  the  night  the  juice,  which  is  of  a  white  milky 
appearance,  oozes  out,  apparently  from  the  vessels  of  the  bark  of  the 

capsules,  and  adheres  to  the  sides  of  the  incision.  In  the  morning  I  his 
is  scraped  off,  and  deposited  in  an  earthen  pot,  where  it  is  worked  l.y 
wooden  spatulas  in  the  sunshine,  until  it  attains  a  certain  decree  of 
consistency.  It  is  then  formed  by  the  hand  into  cakes.  These  are  laid 
in  earthen  basins  to  be  further  dried,  when  tbey  arc  covered  over  with 
poppy  or  tobacco  leaves.  It  is  then  ready  for  exportation,  and  this  is 
the  opium  of  medicine  and  commerce, 

The  quantity  of  this  article  produced  in  various  parts  of  the  world, 
and  especially  in  Ilindostan,  is  enormous.  To  give  you  some  idea  of  it, 
I  will  merely  state,  that  in  one  year  (1832-3)  upwards  of  3,000,000  of 
pounds  were  smuggled  into  China  from  India,  valued  at  upwards  of  fif- 
teen millions  of  dollars. 

Physical  Properties. — Opium  comes  in  opaque  masses  of  considerable 
size,  of  a  compact  texture.  It  posseses  considerable  tenacity,  and  is 
plastic  under  the  fingers.  Its  color  is  reddish  brown  or  deep  fawn.  Its 
odor  is  peculiar  and  narcotic;  taste  bitter  and  acrid.  When  exposed  to 
the  air  it  becomes  hard,  breaks  with  a  shining  fracture,  and  yields  a 
powder  of  a  yellowish-brown  color. 

Varieties  of  Opium. — These  are  the  Turkey,  the  East  India,  the 
Egyptian,  and  the  European. 

1.  Turkey  Opium. — Of  this  there  are  two  different  kinds,  the  Smyrna 
and  the  Constantinople  opium.  The  first  of  these  is  what  is  commonly 
known  under  the  name  of  Turkey  opium.  It  is  raised  in  Anatolia,  and 
shipped  from  Smyrna,  This  is  considered  as  the  best  opium.  It  comes 
in  irregularly-rounded  or  flat  masses,  covered  with  the  capsules  of  a  spe- 
cies of  rumex.  It  is  sometimes  mixed  with  another  kind,  which  is  in 
balls  or  round  masses,  which  are  hard  and  of  an  inferior  quality.  Turkey 
opium  contains  a  larger  quantity  of  morphine  than  any  other  kind,  the 
average  being  about  eight  per  cent. 

With  regard  to  the  Constantinople  opium,  Guibourt  says  there  are  two 
kinds — the  one  comes  in  large  flattened  masses  like  the  Smyrna  opium. 
This  is  of  a  good  quality.  The  other  comes  in  small  flattened  cakes,  from 
two  to  two  and  a  half  inches  in  diameter,  and  always  covered  with  the 
poppy  leaf,  the  median  nerve  of  which  usually  marks  the  middle  of  the 
mass.  The  odor  of  this  kind  is  similar  to  the  preceding,  only  feebler. 
When  exposed  to  the  air  it  dries  and  blackens. 

By  some  it  is  supposed  that  the  Constantinople  opium  is  the  same  as 
the  Smyrna,  remanufactured  and  adulterated  with  gum  at  Constantinople. 
Guibourt,  however,  suggests  that  the  difference  may  be  owiug  to  the  ori- 


360  MATERIA    MEDIC  A   AND   THERAPEUTICS. 

ginal  preparation  of  it,  by  expressing  the  poppy  juice,  and  mixing  this 
with  the  juice  obtained  from  the  simple  incisions. 

The  Constantinople  opium  is  more  mucilaginous  than  the  Smyrna — is 
never  covered  with  the  rumex,  and  contains  only  about  one-half  the 
-quantity  of  morphine. 

2.  East  India  Opium. — This  is  very  inferior  to  the  Turkey  opium.  It 
very  seldom  comes  to  the  United  States.  It  is  chiefly  sent  to  China, 
where  an  immense  quantity  of  it  is  sold.  There  are  different  kinds  of 
it.  Some  is  in  large  balls,  weighing  three  or  four  pounds,  covered  with 
a  case  half  an  inch  thick,  made  of  tobacco  leaves  and  poppy  petals 
agglutinated  together;  with  these  the  opium  is  of  a  pitch-like  mass. 
This  is  commonly  called  Bengal  opium.  It  has  a  strong  empyreumatic 
smell,  but  not  much  of  the  peculiar  narcotic,  heavy  odor  of  Turkey 
opium.  Its  taste  is  more  bitter,  equally  nauseous,  but  less  acrid.  Its 
color  is  blacker,  and  its  texture  less  plastic,  but  more  friable. 

East  India  opium  contains  about  half  the  quantity  of  morphine  which 
Smyrna  opium  does. 

3.  Egyptian  Opium. — This  comes  in  round  flattened  masses,  about 
three  inches  in  diameter,  of  a  regular  shape,  and  appears  to  have  been 
covered  with  some  leaf,  of  which  only  the  vestiges  remain.  It  comes 
from  Egypt,  and  is  distinguished  from  the  Smyrna  opium  by  its  red 
color,  resembling  that  of  the  true  hepatic  aloes;  by  its  odor  being  weaker 
and  somewhat  musty.  Exposure  to  the  air  does  not  blacken  it,  and  it 
softens  instead  of  drying,  in  consequence  of  which  its  surface  is  shining, 
and  it  sticks  to  the  finger ;  and,  finally,  by  its  texture  being  uniform  and 
not  granulated,  showing,  according  to  Guibourt,  that  it  was  mixed  before 
it  was  made  into  masses. 

According  to  Guibourt,  this  contains  less  morphine  than  Smyrna 
opium,  in  the  proportion  of  five  to  seven.  It  differs,  however,  very 
much  in  this  respect. 

4.  European  Opium. — In  France,  Germany,  and  England,  very  good 
opium  is  obtained  from  the  poppy.  It  can  never,  however,  become  an 
object  of  cultivation  in  these  countries  from  the  great  cheapness  of 
foreign  opium.  English  opium  resembles  very  much  the  Egyptian,  and 
yields,  in  some  cases,  seven  per  cent,  of  morphine.  From  the  French 
opium,  Pelletier  obtained  as  much  as  ten  per  cent. 

Purity  and  Strength  of  Opium. — As  brought  into  the  market,  opium 
is  generally  very  impure,  being  mixed  with  various  articles,  such  as  the 
extract  produced  by  boiling  the  poppy,  cow  dung,  ashes,  and  dried  leaves 
of  the  plant,  extract  of  liquorice,  gum  arabic,  tragacanth,  aloes,  flour,  oil, 
and  various  other  articles.  To  increase  the  weight,  bullets,  stones,  fruits, 
&c,  are  also  mixed  with  it. 

Besides  this  the  strength  of  opium  is  modified  by  the  quantity  of 
water  combined  with  it.     Some  is  quite  soft,  some  hard. 


NARCOTICS.  801 

Again,  the  strength  varies,  as  before  Btated,  according  to  the  locality 
where  the  poppy  is  grown. 

To  ascertain  the  real  Btrength  of  opium,  the  only  certain  mode  is  to 
find  out  the  quantity  of  morphine  which  it  contains. 

Mode  of  Detecting  Impurities. — By  physical  examination.  In  this 
stones,  etc.,  may  be  discovered.     Make  a  decoction   of  the  suspected 
article  and  strain.     In  this  way  Pereira  detected  ten  drachms  of  stoi 
and  gravel   in  ten  ounces  of  opium.     If  to  a  decoction  of  opium,  when 
cold,  tincture  of  iodine  he  added,  and  a  blue  precipitate  (iodide  of  Btarch) 
be  thrown  down,  it  shows  the  presence  of  flour  or  starch. 

The  quantity  of  water  in  opium  is  to  be  judged  of  by  the  consi  tence 
and  the  loss  on  drying.  Opium  may  be  considered  as  of  inferior  quality 
when  it  is  very  soft,  greasy,  light,  friable,  of  an  intensely  black  color, 
mixed  with  herbaceous  substances,  or  exhibiting  dark  brovm  or  black 
patches  of  extract.  A  weak  or  empyreumatic  odor,  a  slightly  bitter,  acrid, 
or  siveetish  taste,  and  the  power  of  marking  a  brown  or  black  continuous 
streak  when  drawn  across  paper,  are  also  signs  of  poor  opium. 

To  ascertain  the  quantity  of  morphine,  Pereira  recommends  the  fol- 
lowing process:  "Prepare  an  aqueous  extract  of  the  opium  to  be 
examined,  and  dissolve  it  in  water ;  add  ammonia  to  the  boiling  liquor, 
and  when  cool,  filter;  wash  the  precipitate  on  the  filter  with  cold 
water,  dry  it,  mix  it  with  proof  spirit,  and  add,  drop  by  drop,  acetie 
acid,  until  the  solution  slightly  reddens  litmus.  By  this  means  the 
morphine,  and  not  the  narcotine,  is  dissolved.  Precipitate  the  morphine 
from  the  filtered  solution  by  ammonia." 

Chemical  Properties. — From  the  great  importance  of  opium  as  an 
article  of  the  Materia  Medica,  its  chemical  character  has  been  investi- 
gated with  the  utmost  diligence.  It  is  only,  however,  to  the  chemists 
of  the  present  century  that  we  are  indebted  for  any  accurate  knowledge 
in  relation  to  it.  In  1803,  the  first  discovery  of  importance  was  made 
by  Derosne,  who  detected  in  it  the  peculiar  crystalline  substance  now 
known  by  the  name  of  narcotine,  but  at  first  called  the  salt  of  Derosne.. 
In  1804,  Seguin  discovered  another  crystalline  substance  in  opium. 
Although  he  described  the  properties  of  it,  he  did  not  identify  it  as  an 
alkali.  About  the  same  time  this  latter  substance  was  also  obtained  by 
Sertuerner,  of  Eimbeck  in  Hanover ;  but  it  was  not  until  so  late  as  the 
year  181*7  that  this  chemist  distinctly  promulgated  the  fact  that  this 
substance  was  of  an  alkaline  character,  and  that  it  existed  in  combination 
with  a  peculiar  acid.  The  alkaline  principle  he  supposed  to  contain  the 
active  part  of  the  opium,  aud  to  this  he  gave  the  name  of  morphine, 
while  the  acid  was  called  meconic.  By  the  subsequent  observations  of 
Robiquet,  not  merely  the  character  of  morphine  as  au  alkaline  substance 
was  confirmed,  but  it  was  ascertained  that  the  salt  of  Derosne  was  an 

entirely  different  principle.  By  him  the  name  of  narcotine  was  given  to  it. 


362  MATERIA   MEDICA   AND   THERAPEUTICS. 

The  foregoing  account  is  interesting,  not  merely  in  itself,  but  as  it  led 
the  way  to  all  those  discoveries  which  have  since  been  made  of  the 
existence  of  alkaline  substances  in  a  great  variety  of  vegetables. 

According  to  the  most  recent  analysis,  opium  may  be  considered  as 
made  Up  of  the  following  constituents.  It  is  one  of  the  most  complex 
articles  in  the  Materia  Medica. 

[Its  composition  is  not  even  now  entirely  well  settled.  The  following 
principles  are  certainly  contained  in  opium — morphia,  narcotina,  codeia, 
narceina,  meconine,  thebaina,  meconic  acid,  porphyroxin,  and  sometimes 
pseudomorphia.  It  also  contains  gum,  extractive,  fat,  caoutchouc,  resin, 
and  more  or  less  ivater. 

1.  Morphia  or  Morphine,  the  important  principle  of  opium,  will  be 
treated  of  hereafter. 

2.  Codeia  or  Codeine,  so  called  from  the  Greek  name  of  the  poppy 
head — a  white  crystalline  solid,  soluble  in  water,  alcohol,  ether,  a  weak 
solution  of  potash.  Its  reactions  are  alkaline,  and  it  forms  salts  with 
acids.     They  have  not  been  much  studied. 

3.  Narcotina  or  Narcotine. — A  white  inodorous  substance,  crystalliz- 
ing in  prisms  which  are  fluted  or  striated,  distinguished  from  morphine 
being  insipid ;  very  soluble  in  ether,  insoluble  in  alkaline  solutions.  It 
does  not,  like  morphia  and  codeia,  affect  vegetable  colors.  Slightly 
soluble  in  hot,  but  not  in  cold  water.  Soluble  in  100  parts  cold  or  24 
boiling  alcohol.  Its  salts  are  more  bitter  than  those  of  morphine,  redden 
litmus,  and  are  precipitated  from  solution  by  infusion  of  galls. 

4.  Narceina  or  Narceine. — A  white  inodorous  solid,  crystallizes  in  silky 
needles,  radiating  in  tufts.  Taste  slightly  bitter  and  somewhat  metallic 
soluble  in  water,  fuses  at  about  198°.  It  has  no  action  on  vegetable 
colors,  nor  does  it  combine  with  acids  to  form  salts.  It  is,  therefore,  a 
neutral  principle.  Narceine  is  rendered  blue  by  mineral  acids,  when  so 
dilute  as  not  to  decompose  it.  The  color  disappears  when  much  water 
is  added,  but  the  narceine  can  be  restored  by  saturating  the  acids  by 
ammoniac.  It  forms  with  iodine  a  bluish  compound  (iodide  of  narceine). 
Heat  and  alkalies  destroy  this  color. 

Meconine. — A  white,  crystalline,  colorless  solid ;  taste  at  first  slight 
afterwards  acrid.  Fuses  at  194°,  becoming  a  colorless,  limpid  fluid. 
Soluble  in  water,  alcohol,  or  ether.  Distinguished  from  morphia  or 
codeia  by  not  possessing  alkaline  properties.  Meconine  is  remarkable 
for  not  containing  nitrogen.     It  is  probably  inert. 

Thebaina  (Paramorphia). — A  white  crystalline  solid,  having  an  acrid 
styptic  taste,  soluble  in  ether  and  alcohol,  but  hardly  at  all  so  in  water. 
Fuses  at  302°.  Dissolves  in  weak  acids,  but  does  not  form  crystallizable 
salts.  Pelletier  considered  it  isomeric  with  morphia,  and  therefore 
called  it  paramorphia.  One  grain  injected  into  the  jugular  vein  causes 
tetanus  and  death  in  a  few  minutes. 


NARCOTICS.  869 

Mrconic  yield. — A  tribasic  acid,  found  i r»  the  poppy  only.  When 
pure  baa  the  form  of  white,  transparent,  micaceous  scales.  Soluble  in 
boiling  water,  but  decomposed  by  it,;  slightly  soluble  in  cold  water,  and 
more  freely  in  alcohol.     Relieved  to  be  inert. 

Porphyroxinc. — The  name  given  by  Meek  to  a  new  principle  which 
he  found  in  Bengal  opium.  Crystallizes  in  shining  needles,  soluble  in 
alcohol  and  ether,  insoluble  in  water.  It  is  neutral.  Its  most,  remark. 
able  characteristic  is  the  property  of  assuming  a  rose  color  when  heated 
in  dilute  muriatic  acid. 

Pseudo  morphia. — This  substance  is  only  occasionally  found  in  opium. 
It  is  a  whitish  solid,  reddened  by  nitric  acid,  soluble  in  caustic  alkalies. 
It  docs  not  form  salts  with  acids.     It  is  not  poisonous.] 

Opium  is  partially  soluble  in  water,  alcohol,  ether,  wine,  acetic  and 
citric  acids.     Its  best  menstruum  is  proof  spirit. 

Effects  on  the  System.  —  Like  all  narcotics,  this  substance  differs 
greatly  in  its  effects  according  to  the  quantity  in  which  it  is  taken.  In 
moderate  doses,  its  primary  effect  is  to  excite  the  system.  The  pulse  is 
slightly  increased  in  force  and  frequency,  and  a  sense  of  fulness  is 
experienced  in  the  head ;  the  energy  of  the  system  is  increased  ;  the 
mind  is  exhilarated ;  the  ideas  flow  more  quickly,  and  a  comfortable  and 
pleasant  sensation  is  experienced  throughout  the  whole  system.  After 
continuing  for  a  short  time  these  effects  pass  off,  and  are  followed  by  a 
general  diminution  of  the  energy  and  sensibility  of  the  system  ;  external 
agents  lose  their  influence  on  the  body;  pain,  if  present,  is  relieved, 
and  a  tranquil  serenity  pervades  the  system.  Finally,  all  this  is  suc- 
ceeded by  drowsiness  and  sleep.  The  average  period  during  which  the 
exciting  operation  of  opium  continues  is  from  half  an  hour  to  an  hour, 
while  the  sedative  effects  continue  for  seven  or  eight  hours.  On  awak- 
ing from  sleep  there  is  generally  felt  some  nausea  and  headache,  together 
with  slight  tremors — the  appetite  is  impaired,  and  the  bowels  are  left 
more  or  less  constipated. 

When  given  in  doses  somewhat  larger,  all  these  effects  are  produced 
in  a  more  marked  degree.  The  primary  excitement  is  much  greater, 
but  it  passes  off  more  rapidly  and  is  sooner  succeeded  by  the  sedative 
effects,  which  are  also  much  more  marked.  The  general  insensibility  is 
greater — the  pulse  is  slower,  the  sleep  more  profound,  approaching  to  a 
state  of  stupor.  The  constitutional  disturbance  left  behind  it  is  also 
greater. 

In  poisonous  doses,  the  sedative  effects  of  opium  principally  show7 
themselves,  without  any  of  the  stimulating  effects.  Giddiness  and  stupor 
speedily  come  on.  There  is  loss  of  sense  and  motion — the  breathing  is 
slow  but  easy — the  features  become  ghastly — the  pupil  is  contracted — 
the  pulse  is  feeble,  and  death  succeeds. 

Such,  briefly  detailed,  are  the  effects  of  opium  ou  the  system.     For  the 

24 


364  MATERIA.    MEDICA    AND   THERAPEUTICS. 

purpose  of  understanding  them  more  fully  we  shall  analyze  the  various 
effects  produced  on  the  different  organs  and  tissues  of  the  body. 

1.  On  the  Brain  and  the  Nervous  System. — When  opium  is  taken 
into  the  stomach,  it  makes  its  primary  impression  on  the  nerves  of  that 
organ.  The  brain  and  the  rest  of  the  nervous  system  are  next  affected. 
That  the  nervous  system  is  specially  acted  on  is  manifest  from  all  the 
effects.  To  this  are  owing  the  primary  excitement  and  subsequent  in- 
sensibility. With  regard  to  the  brain,  it  is  evident  that  a  greater  or  less 
accumulation  of  blood  takes  place  in  the  cerebral  vessels.  Where  the 
dose  has  been  large  this  is  particularly  striking,  and,  where  death  results, 
is  proved  by  dissection.  As  a  general  rule,  in  these  cases,  turgescence 
of  the  vessels  and  effusion  into  the  ventricles  are  met  with. 

The  prominent  effects  then  on  the  nervous  system  are  primary  excite- 
ment and  subsequent  depression  and  insensibility.  In  large  doses,  cere- 
bral congestion,  profound  sleep,  coma,  insensibility,  paralysis,  an4  con- 
traction of  the  pupils. 

2.  On  the  Vascular  System. — A  great  difference  of  opinion  has  exist- 
ed in  relation  to  the  effects  of  opium  on  the  circulation.  According  to 
the  experiments  of  Crumpe,  the  pulse  at  first  becomes  accelerated,  but 
afterwards  reduced  to  the  natural  standard  and  even  below  it.  In  expe- 
riments made  by  Dr.  Bard,  on  the  contrary,  the  pulse  from  the  begin- 
ning is  stated  to  have  been  slower  than  natural.  It  is  to  be  observed, 
however,  that  Dr.  Bard  does  not  give  any  account  of  the  state  of  the 
pulse  until  half  an  hour  had  elapsed  after  taking  the  opium.  During 
this  period  he  probably  would  have  found  the  pulse  accelerated.  The 
truth  is,  however,  that  the  pulse  varies  under  the  influence  of  this  drug. 

As  a  general  rule  it  is  moderately  excited  at  first,  but  as  the  system 
gets  under  the  influence,  it  becomes  slower  and  fuller.  In  poisonous 
doses,  the  pulse  appears  to  vary  still  more — being  sometimes  much  in. 
creased  in  frequency,  small  and  irregular — at  other  times  fuller  and 
slower  than  natural.     (Christison.) 

In  the  capillary  vessels,  the  experiments  of  Alston  show  that  under 
the  influence  of  opium,  the  circulation  is  rendered  slower  and  a  conse- 
quent congestion  takes  place.  As  the  result  of  this,  blood  accumulates 
in  the  larger  blood-vessels,  and  the  vessels  themselves  become  distended. 
Hence  the  increased  fulness  of  the  pulse  and  the  sense  of  fulness  about 
the  head  and  chest  which  are  experienced.  (Edin.  Med.  Essays,  vol.  v. 
p.  129.) 

8.  On  the  Mucous  System. — The  effect  here  is  to  check  secretion  and 
exhalation,  and  this  is  owing  to  a  peculiar  action  on  the  secretory  ves- 
sels. This  effect  is  observable  in  almost  every  portion  of  the  mucous 
membrane.  In  that  lining  the  mouth  and  throat,  by  dryness  and  thirst. 
In  the  trachea  and  bronchial  tubes,  by  the  diminished  expectoration 
which  takes  place  in  morbid  states  of  the  membrane  lining  these  parts. 


NAEOOTICS.  885 

In  the  membrane  lining  tlie  stomach  and  bowels,  l>\  the  loss  of  appe- 
tite and  by  the  discharges  from  the  bowels  being  less  copioui  and 

li(jiiid. 

4.  On.  the  <U<mdal.«r  System. — The  general  effect  of  opium  on  the 
glands  is  to  lessen  their  secretion.  Thus  the  liver,  under  its  influence, 
secretes  less  bile.  This  is  proved  by  the  evacuation  from  the  bowi 
If  one  or  two  doses  of  opium  be  taken  immediately  after  the  bo 
have  been  avacuated,  the  next,  discharge  will  be  of  the  peculiar  whitish 
or  ash  color  which  indicates  the  absence  of  bile.  On  the  pancreas,  we 
infer  that  a  similar  eifeet  is  produced,  although  we  have  not  the  same 
evidence  of  the  fact.  That  the  secretion  from  the  salivary  glands  is  im- 
paired by  opium  is  evident  from  the  dryness  of  the  mouth  and  from  the 
effect  in  checking  excessive  salivation.  On  the  kidneys  the  same  effect 
is  produced — the  secretion  of  urine  being  generally  lessened.  I  have 
known  it  absolutely  arrested  for  eighteen  hours  by  an  opium  supposi- 
tory. 

5.  On  the  Cutaneous  System. — Here  the  effect  of  opium  is  peculiar. 
Instead  of  restraining  the  secretion  from  the  skin,  as  it  does  the  others, 
it  creates  a  determination  to  the  surface  and  promotes  perspiration.  In 
some  cases,  it  causes  a  sense  of  pricking  and  itching,  terminating  occa- 
sionally in  an  eruption. 

6.  On  the  Respiratory  System. — Here  the  effect  is  to  render  respira- 
tion slower.  Where  poisonous  doses  have  been  taken,  the  breathing 
frequently  becomes  stertorous. 

7.  On  the  Intestines. — The  general  effect  of  opium  is  to  produce  con- 
stipation by  diminishing  the  secretion  of  bile,  by  lessening  the  secretion 
from  the  mucous  membrane  of  the  intestines,  by  impairing  the  muscular 
contractility  of  the  canal,  by  rendering  the  intestines,  more  or  less,  insen- 
sible to  the  natural  stimulus  of  their  contents. 

S.  On  the  Muscular  System. — During  the  primary  operation  of  opium 
the  muscular  power  may  be  increased,  but  the  final  effect  is  to  impair 
its  energy  and  cause  relaxation.  This  is  seen  in  various  parts  of  the  mus- 
cular system.  The  muscular  power  of  the  stomach  and  intestines  is  less- 
ened. The  power  of  the  bladder  is  also  impaired.  This  latter  is  proved 
by  the  fact  that  under  the  influence  of  opium  the  bladder  frequently 
becomes  distended  with  urine,  while  none  of  it  is  evacuated — showing 
an  abundance  in  the  secretion,  but  an  inability  on  the  part  of  the  blad- 
der to  evacuate  it. 

Circumstances  Modifying  the  Effects  of  Opium. — The  two  circum- 
stances by  which  the  effects  of  opium  are  modified  were  alluded  to  when 
speaking  of  narcotics  generally,  viz.  age,  and  the  habit  of  using  them.  All 
that  was  then  said  of  the  class  of  narcotics  is  specially  applicable  to  this 
drug.  It  is  not  necessary  to  go  into  any  recapitulation  here,  but  the 
great  importance  of  the  subject  will  justify  a  repetition  of  the  caution 


366  MATERIA    MEDICA   AND   THERAPEUTICS. 

then  given  as  to  the  exhibition  of  opiates  to  young  children.  Too  much 
caution  cannot  he  taken  in  giving  any,  even  the  simplest  and  safest  or 
rather  least  dangerous  of  the  preparations  of  opium  to  children.  You 
can  never  calculate  beforehand  how  they  will  be  affected  by  them.  Do 
not  suppose  that  I  denounce  opium  in  the  diseases  of  children  ;  it  is  most 
valuable — often  indispensable,  if  only  it  is  given  wisely. 


VARIOUS    MODES    IN    WHICH    OPIUM    MAY    BE    APPLIED    TO    THE    SYSTEM. 

These  are  four — introducing  it  into  the  stomach,  applying  it  to  the 
skin,  introducing  it  into  the  rectum,  and  injecting  it  into  the  veins. 

Introducing  it  into  the  Stomach — The  ordinary  mode  of  using  it, 
and  as  a  general  rule  the  most  efficacious. 

Introducing  it  into  the  Rectum — Is  the  next  most  common  mode, 
and  a  very  convenient  and  efficacious  one  where  from  the  nature  of  the 
case  it  cannot  be  swallowed,  or  where  from  irritability  of  the  patient's 
stomach  it  is  rejected.  In  this  way  solid  opium  may  be  introduced  in 
the  shape  of  a  suppository,  as  it  is  called  ;  or  the  tincture  of  opium 
added  to  a  small  quantity  of  fluid  may  be  injected.  In  using  it  in  this 
latter  way  it  is  important  to  recollect  that  the  size  of  the  injection 
should  be  as  small  as  possible — otherwise  from  mere  mechanical  disten- 
sion the  rectum  will  be  excited  and  expel  the  injection,  and  the  effect 
of  the  article  will  be  lost.  By  some  it  is  supposed  that  opium  intro- 
duced into  the  rectum  operates  more  powerfully  on  the  system  than 
when  taken  into  the  stomach.  Orfila  in  particular  has  attempted  to 
establish  this.  So  has  Dupuytren.  A  question  of  this  kind,  however^ 
can  easily  be  settled  by  ordinary  observation,  and  this  has  established 
the  fact  that  its  action  is  by  no  means  so  energetic.  As  a  general  rule, 
at  least  double  the  quantity  is  required  to  produce  the  same  effect  on 
the  system. 

When  applied  to  the  unbroken  skin,  the  effect  of  the  opium  is  limited 
in  a  great  measure  to  its  topical  operation^  and  in  this  way  it  is  fre- 
quently very  efficient  in  allaying  irritation  and  pain.  If,  however,  the 
cuticle  be  removed,  or  if  it  be  applied  to  the  surface  of  wounds  or 
ulcers,  it  produces  all  its  constitutional  effects.  Sir  Astley  Cooper 
states  that  he  has  known  a  solution  of  opium  applied  upon  an  extensive 
scald  in  a  child  to  destroy  life.  "The  manner  in  which  we  get  the 
effects  of  opium  at  present  by  external  application  is  by  the  use  of  some 
of  the  salts  of  morphine  by  the  endermic  method.  The  cuticle  is  first 
separated  by  means  of  a  small  blister,  and  then  about  a  quarter  of  a 
grain  of  the  acetate  or  sulphate  of  morphine  is  to  be  applied  to  the 
abraded  surface.  It  may  be  applied  either  in  the  form  of  powder,  solu- 
tion, or  cerate.     The  best  place  for  applying  it  is  the  back  of  the  neck. 


NAECOTICS,  361 

According  to  Lembert,  the  inventor  of  the  endermic  method,  it  opei 
more  powerfully  here  than  when  applied  to  any  other  part.     A.pp 
in  this  way  it  produces  all  the  usual  effects  of  the  article,  the  same  as 
when  taken   by  the  mouth — and  it  has  been   used   in   this  way  very 
successfully  in  the  management  of  a  number  of  complaints  of  a  painful 
character,     [It  is  dreadfully  painful,  crede  experto.j 

Injecting  into  the  veins  has  been  attempted  in  one  case  by  Coindet  of 
Geneva.  The  patient  was  a  girl  of  fourteen  years  of  age  affected  with 
tetanus.  Opium  internally  having  failed  to  produce  any  effect,  lie 
dissolved  a  scruple  of  opium  in  warm  distilled  water  (the  quantity  i 
not  mentioned)  and  then  filtered.  A  residuum  of  VI  grs.  was  left  on 
the  paper,  but  "  the  narcotic  principles  were  almost  all  in  the  solution/1 
An  opening  was  made  in  the  basilic  vein  of  the  right  arm,  and  with  a 
fine  syringe  a  drachm  was  injected  every  five  minutes  until  five  injec- 
tions were  made.  No  alarming  symptoms  occurred,  and  the  patient 
recovered.  The  vein  was  slightly  inflamed,  but  this  was  gradually  and 
easily  relieved  by  leeches  and  cold  applications.  ■"  The  patient  described 
the  effect  of  the  injections  as  if  a  torrent  of  liquid  fire  had  been  poured 
through  the  veins  of  the  arm,  concentrating  in  her  chest,  and  thence 
dispersed  over  the  whole  body,  attended  with  violent  beat  and  pricking 
of  the  skin.  These  sensations,  she  said,  were  of  a  most  painful  nature."* 
The  foregoing  experiment  shows  that  opium  may  be  injected  into  the 
veins  without  fatal  results.  Still  the  practice  is  a  dangerous  one,  and 
ought  not  to  be  resorted  to  except  in  the  most  extreme  cases. 


CONDITIONS    OF    SYSTEM    FAVORABLE    AND    UNFAVORABLE    TO    ITS    USE. 

From  the  decided  effects  of  opium  it  is  evident  that  it  cannot  be  used 
in  all  conditions  of  the  system  with  impunity,  much  less  with  advantao-e. 
While  in  some  it  proves  not  merely  a  safe  but  salutary  agent,  in  others 
its  use  is  attended  with  the  greatest  danger.  It  becomes,  then,  import- 
ant to  know,  if  possible,  the  conditions  under  which  it  may  or  may  not 
be  used. 

1.  In  the  first  place,  a  plethoric  .condition  of  the  system  is  unfavorable 
to  its  use.  The  reason  of  this  is  obvious  from  what  has  been  said  in 
relation  to  its  general  effects.  Given  in  certain  quantities  we  know 
that  it  produces  congestion  of  the  brain,  and  in  some  cases  apoplexv. 
When  the  habit  is  plethoric  this  of  course  is  much  more  likely  to 
occur,  and  may  do  so  even  from  moderate  doses. 

2.  In  the  second  place,  ivherever  there  exists  determination  to  the  brain 
it  ought  not  to  be  used.  In  this  state  of  things  the  necessarv  effect  of 
opium  is  to  increase  the  difficulty. 

*  Johnson's  Medico-Chirurgical  Review.  toL  iv.  p.  936. 


368  MATERIA    HEDICA   AND   THERAPEUTICS. 

3.  In  the  third  place,  wherever  general  inflammatory  excitement  is 
'present  it  ought  to  be  used  with  great  caution.  In  this  condition  of  the 
system  it  acts  as  an  additional  stimulant,  causing  frequently  unpleasant 
determination  to  the  brain,  shutting  up  all  the  secretions,  and  thus  aug- 
menting the  general  excitement.  I  do  not  mean  by  this  to  say  that 
opium  should  not  be  used  in  inflammatory  complaints ;  it  may  be,  and 
sometimes  with  great  advantage,  but  there  must  also  be  some  prelimi- 
nary or  accompanying  treatment  to  modify  the  inflammatory  action  to 
enable  us  to  use  opium  safely. 

With  regard  to  the  condition  of  the  system  favorable  to  its  use,  it  is  that1 
in  which  the  bloodvessels  have  been  properly  evacuated,  their  action 
suitably  reduced,  the  surface  free,  the  tongue  moist,  and  no  determination 
to  the  brain  present.  When  these  conditions  obtain,  it  may  safely  be 
given,  should  the  case  require  it. 


OF    THE    APPLICATION    OF    OPIUM    IN    THE    TREATMENT    OF   DISEASES. 

As  a  remedial  agent,,  opium  has  always  and  justly  been  looked  upon 
as  one  of  the  most  valuable  in  our  possession.  It  has  been  styled  the 
donum  Dei,  the  gift  of  God  to  man,  and  Sydenham  says  of  it,  that  it  is 
"■so  necessary  an  instrument  in  the  hands  of  a  skilful  physician  that  the 
art  of  physic  would  be  defective  and  imperfect  without  it;  and  whoever 
is  thoroughly  acquainted  with  its  virtues  and  the  manner  of  using  it,, 
will  perform  greater  things  than  might  reasonably  be  expected  from  the 
use  of  a  simple  medicine."*  High  as  this  panegyric  is-,  it  is  unquestion- 
ably just.  Admirable,  however,  as  this  agent  is,  if  properly  used,  it  is 
equally  true  that  in  unskilful  hands  there  is  scarcely  any  capable  of 
producing  a  greater  amount  of  mischief.  That  this  must  be  the  case  is- 
evident  from  the  effects  which  it  produces,  and  particularly  from  the 
difference  in  these  effects,  according  to  the  dose  in  which  it  is  givenr 
and  the  precise  condition  of  the  system  at  the  time.  Too  much  care, 
therefore,  cannot  be  exercised  in  studying  its  effects,  or  in  discriminating 
the  condition  of  the  system  in  whieh  it  may  be  safely  and  advantage- 
ously used. 

For  the  purpose  of  illustrating  its  effects,  I  will  now  notice  briefly 
some  of  the  diseases  in  which  it  is  most  frequently  resorted  to. 

Fevers. — In  this  class  of  diseases  it  is  used  continually,  but  for  vari- 
ous purposes,  according  to  the  character  of  the  fever  and  the  condition 
of  the  system.  In  the  intermittent  form  of  fever,  it  is  mainly  used  for 
one  purpose,  and  this  is  to  arrest  or  modify  the  paroxysm ;  according 
to  the  manner  in  which  it  is  given,  it  may  either  prevent  entirely  the 

*  P.  115. 


NAKCOTH'S.  369 

return  of  the  paroxysm,  or  mitigate  its  violence  as  well  as  its  duration, 
To  prevent  tin;  paroxysm  altogether,  it  should  be  given  in  a  Buitable 
dose  about  an  hour  before  the  time  of  its  expected  return,  and  as  a 

general  rule  it  lias  the  desired  effect. 

As  a  general  rule,  you  will  not  find  it  necessary  to  have  recourse  to 
opium  in  this  way  in  the  management  of  intermittent  fever;  the  action 
of  quinine  is  prompt  enough  to  answer  every  purpose.  Occasionally, 
however,  you  will  find  it  a  valuable  resource,  especially  when  danger  is 
apprehended,  either  from  the  violence  of  the  paroxysms  or  from  the 
debility  of  the  patient.  [Dr.  Drake  says  of  opium  in  the  treatment,  of 
malignant  intermittents,  "of  its  great  value  no  physician  of  experience 
can  entertain  a  doubt.  If  there  be  no  diarrlioea,  however,  it  is  not 
necessary  to  administer  it  throughout  the  intermission,  but  reserve  it 
for  the  last  close  of  sulphate  (of  quinine)  before  the  approaching  chill. 
The  quantity  in  which  it  is  given  is  often  entirely  too  small.  Three  or 
four  times  as  much  as  would  be  required  in  an  ordinary  ague  is  not  a 
large  close.  Four  grains  of  opium  with  eight  grains  of  sulphate  three 
or  four  hours  before  the  chill."] 

By  some  opium  has  been  given  in  the  cold  stage.  This  was  the 
practice  of  Dr.  Trotter.  By  Dr.  Lind  it  was  given  in  the  hot  st'tge, 
about  half  an  hour  after  it  had  commenced,  and  with  uniform  success 
in  shortening  the  paroxysm  and  mitigating  all  the  febrile  symptoms. 
When  used  in  this  way,  he  states  it  to  be  followed  by  refreshing  sleep 
and  a  more  free  perspiration,  causing  in  this  way  a  more  perfect  inter- 
mission. On  this  account,  he  says,  less  bark  is  necessary  to  effect  a 
final  cure.  The  practice  of  Lind  has  been  tried  by  others,  and  with 
similar  success. 

In  the  continued  forms  of  fever,  opium  is  an  article  which  should  be 
used  with  caution,  and  in  its  use  every  regard  should  be  had  to  the 
period  of  the  disease  and  the  actual  condition  of  the  system.  Early  in 
the  disease  when  great  excitement  is  present,  characterized  by  a  strong 
and  frequent  pulse,  hot  skin,  flushed  face,  headache,  &c,  it  is  manifestly 
improper,  and  would  inevitably  aggravate  the  symptoms.  On  the  other 
hand,  in  the  later  periods  of  the  disease,  where  general  debility  has 
come  on,  and  where  morbid  irritability  is  present,  unattended  by  inflam- 
mation, it  may  be  used  with  great  advantage,  both  as  a  general  stimu- 
lant to  support  the  sinking  powers  of  the  system,  and  with  the  view  of 
relieving  particular  symptoms — such  as  sleeplessness,  morbid  irritation 
of  the  brain,  diarrhoea,  snbsultus  tendinum,  &c. 

The  other  mode  of  using  opium  in  fever  is  for  the  relief  of  par- 
ticular symptoms  depending  upon  morbid  irritation.  Among  the  svmp- 
toms  or  conditions  for  which  it  may  be  used,  the  following  are  the 
principal :  1.  The  want  of  sleep.  This  is  a  constant  and  distressing 
occurrence  in  fever,  one  which  adds  greatly  to  the  protraction  of  the 


370  MATERIA    MEDICA   AND   THERAPEUTICS. 

disease  and  the  exhaustion  of  the  patient.  To  obtain  sleep  is  a  matter 
of  great  importance,  and  it  may  be  produced  by  opium,  if  properly 
given.  For  this  purpose,  all  those  circumstances  should  be  attended  to 
which  I  have  already  mentioned- as  favorable  to  the  action  of  this  agent. 
Where  there  is  great  cerebral  excitement,  or  inflammation  of  that  organ 
is  present;  where  the  blood-vessels  are  too  full,  the  skin  hot  and  dry, 
and  the  secretions  generally  locked  up,  opium  will  usually  fail  in  the 
object  intended.  All  these  circumstances,  therefore,  should  be  carefully 
attended  to  and  corrected. 

2.  Sometimes  it  is  used  to  relieve  delirium.  In  using  it  for  this  pur- 
pose, however,  it  is  to  be  recollected  that  delirium  may  depend  upon 
different  and  opposite  states  of  the  system.  Thus,  it  may  depend  upon 
inflammation  of  the  brain,  or  upon  irritation  of  that  organ,  the  result  of 
general  and  local  debility.  .In  the  two  cases  you  will  find  opium  act 
differently.  In  the  first,  it  does  no  good,  and  frequently  aggravates.  In 
the  second,  it  may  be  of  service.  Even  in  the  latter  case,  however,  it 
must  be  used  with  caution.  Large  doses  of  opium  act  as  sedatives,  and 
thus  add  to  the  exhaustion  of  the  patient.  In  most  cases,  tonics  and 
stimulants  will  generally  answer  better  than  opium.  Occasionally,  the 
additional  use  of  opium  may  prove  of  service. 

3.  It  may  be  used  for  the  purpose  of  checking  diarrhoea.  [Opium  is 
much  more  frequently  used  in  typhus  and  typhoid  fevers  than  formerly. 
Speaking  of  its  use  in  typhus  fevers,  Dr.  Gerhard  says  :  "  Opium  was 
used  in  a  considerable  number  of  cases.  When  insomnia  had  been  tor- 
menting and  incessant,  the  patient  exhausted  by  agitation  and  nervous 
restlessness,  small  doses  of  morphine  would  generally  calm  the  agitation 
and  procure  sleep.  This  advantage  was  so  great,  that  we  were  induced 
to  give  opium  in  cases  which  were  opposed  to  our  ordinary  notions  of  the 
proper  condition  of  the  system  for  their  employment.  We  observed  no 
inconvenience  from  them,  but  found  morphia  of  much  benefit.  It  should 
not  be  used  in  large  doses.  Patients  with  typhus  are  certainly  more 
readily  affected  by  its  narcotic  properties  than  in  any  other  disease.  One 
sixth  or  one  eighth  of  a  grain  was  enough.  Opiates  are  improper  when 
there  is  much  dulness  of  intellect,  with  suffused  eye.  They  are  contra- 
indicated  when  the  pupil  is  contracted.  This  was  first  pointed  out  by 
Dr.  Graves,  of  Dublin."  Dr.  Graves  uses  laudanum  with  tartar  emetic 
in  the  advanced  stage  of  typhus,  when  there  is  insomnia,  restlessness, 
and  delirium.  His  prescription  is  :  Tartar  Emetic,  4  grs. ;  Laudanum, 
1  drachm ;  Camphor  Mixture,  6  ounces.  One  or  two  tablespoonfuls 
every  hour  or  two  till  sleep  is  procured.  There  is  no  doubt  that  in  all 
cases  of  typhus,  where  the  nervous  disturbance  marked  by  insomnia, 
subsultus,  delirium,  &c,  exceeds  that  of  the  circulation,  opiates  are 
proper.] 


NARCOTICS.  3  7  I 

Inflammation. — The  use  of  opium  in  inflammation  is  a  subject  of 
great  interest,  and  one,  I  fear,  concerning  which  you  will  find  nothing 
very  satisfactory  in  the  hooks.  It,  is  prescribed  in  a  greal  manj  i 
and  with  advantage,  and  yet  the  principles  upon  which  it  is  used  do  not 
seem  to  me  very  clearly  understood.  In  consequence  of  this,  yon  will 
find  the  use  of  it  frequently  vague  and  empirical.  Now  the  first 
remark  that  I  would  make  is,  that  opium  docs  not  exercise  any  control 
at  all  over  inflammatory  action.  As  an  adjuvant,  however,  to  other 
remedies,  it  may  be  made  exceedingly  useful,  and  should  never  be 
neglected.  Now,  the  objects  for  which  we  use  it  as  an  adjuvant,  are: 
1.  To  allay  the  reaction  which  generally  succeeds  the  loss  of  blood  in 
inflammation.  2.  To  allay  pain  and  irritation  consequent  upon  inflam- 
mation. To  accomplish  these  objects  there  are  two  genera]  modes  in 
which  we  use  it.  By  combining  venesection  and  the  use  of  calomel  and 
tartar  emetic  with  opium.  Now  the  rationale  of  this  combination  is  the 
following,  and  is  perfectly  philosophical.  Calomel  ami  tartar  emetic  co- 
operate most  powerfully  in  subduing  inflammatory  action,  keeping  down 
the  pulse,  and  promoting  all  the  secretions.  By  these  means  the  system 
is  kept  in  a  state  in  which  the  opium  may  be  safely  used,  and  in  this 
way  you  get  from  it  the  only  effect  which  you  wish  to  obtain,  i.  e.  its 
soothing  effects,  while  you  rob  it  of  all  its  exciting  and  disturbing 
qualities. 

Another  mode  of  using  opium  in  inflammation  is  so  to  subdue  the  in- 
flammatory excitement  by  bleeding,  as  that  nothing  need  be  apprehend- 
ed from  the  stimulant  or  astringent  operation  of  the  opium,  but  that 
only  the  sedative  effects  shall  follow.  This  is  done  by  bleeding  at  first 
to  deliquium,  and  then  giving  a  large  dose  of  opium.  If  the  symptoms 
return  the  same  may  be  repeated,  and  to  remove  the  remaining  traces  of 
inflammation,  calomel'  and  ipecac,  with  the  opium  in  smaller  doses,  may 
be  resorted  to.  This  is  the  practice  recommended  by  Dr.  Armstrong. 
(Lect.  394.)  Now,  the  principle  upon  which  he  used  opium  is  simply 
this  :  If  after  free  depletion  you  give  a  large  dose  of  opium,  it  quiets 
the  irritability  of  the  system,  vascular  and  nervous,  and  subsequent 
excitement  is  rendered  so  moderate  as  to  be  manageable  by  the  other 
remedies.  This  is  a  kind  of  treatment  which  you  will  find  very  useful 
in  cases  where  it  is  important  to  husband  the  strength  of  your  patient 
as  it  regards  the  loss  of  blood. 

This,  then,  is  the  principle  upon  which  I  think  opium  ought  to  be 
used  in  inflammation — not  to  arrest  inflammation  itself,  but  to  control 
some  of  the  effects  of  it.  [I  believe  with  the  late  Dr.  Bartlett,  that  the 
use  of  opium  in  inflammation  ought  to  be  restudied,  and  I  feel  very 
confident  that  the  result  of  such  re-study  would  be,  to  establish  Opium  as 
an  antiphlogistic  remedy  second  in  value  to  no  one  other.  Of  its  use  in 
serous  inflammation  and  in  dysentery,  I  shall  speak  hereafter ;   but  it  is 


372  MATERIA   MEDICA    AND   THERAPEUTICS. 

equally  useful  in  bronchitis  with  profuse  secretions,  in  advanced  pneu- 
monia, in  cystitis,  nephritis,  gastritis,  aud  enteritis — in  all  these  inflam- 
mations opiates,  rightly  timed  and  given  in  proper  doses,  are,  as  I  have 
said,  second  in  value  to  no  other  single  remedy.] 

Inflammation  of  Mucous  Membranes. — In  some  of  these  you  will 
find  opium  a  useful  remedy,  while  in  others  it  is  highly  objectionable. 
When  the  mucous  membrane  of  the  stomach  and  bowels  is  the  seat*  of 
inflammation,  opium  may  be  used  with  freedom,  and  generally  with 
great  benefit.  Thus,  for  example,  in  some  cases  oi  poisoning,  the  gastric 
irritation  is  so  great  as  to  require  the  use  of  this  remedy,  and  it  acts 
with  great  effect.  In  dysentery,  too,  it  is  a  remedy  of  great  value.  It 
allays  the  excessive  irritation  of  the  intestines  which  is  present  in  this 
disease,  relieves  the  perpetual  desire  to  go  to  stool,  and  at  the  same 
time  restrains  the  acrid  secretions  from  the  inner  surface  of  the  intes- 
tines. [Laudanum,  with  a  small  quantity  of  ice-cold  water  used  as  an 
enema  after  every  stool  or  every  three  or  four  hours,  has,  in  my  hands, 
done  more  for  the  cure  of  dysentery  than  any  single  remedy.]  Among 
the  best  forms  in  which  it  can  be  given  is  that  of  Dover's  powder.  In 
combination  with  calomel,  it  is  an  admirable  agent  in  the  management 
of  this  disease.  The  calomel  alters  the  action  of  the  mucous  membrane 
— changes  the  character  of  its  secretions — while  the  Dover's  powder 
allays  the  irregular  action  of  the  bowels,  quiets  pain,  and  at  the  same 
time  equalizes  the  circulation  by  determining  to  the  skin. 

In  inflammation  of  serous  membranes,  opium  is  a  remedy  of  great 
value  as  an  adjuvant,  and  may  be  used  with  great  freedom  after  copious 
venesection  ;  especially  is  this  true  of  peritonitis,  in  which  opium  may 
be  given  with  greater  freedom  than  perhaps  in  any  other  inflam- 
mation. 

In  inflammation  of  solid  viscera,  such  as  pneumonia,  hepatitis,  &c, 
opium  may  be  used  in  the  same  way  —  not  per  se,  but  merely  as  an 
adjuvant. 

In  inflammation  of  flhrous  membranes,  such  as  rheumatism  and  gout, 
opium  is  a  remedy  of  special  value,  as  it  fulfils  in  these  cases  the  great 
indication  of  soothing  and  allaying  pain.  Before  using  it  here,  how- 
ever, the  system  must  be  properly  prepared.  If  necessary,  bleeding, 
cathartics,  and  sudorifics,  must  be  resorted  to  ;  when  the  system  is  pro- 
perly evacuated  and  prepared,  then  you  will  find  that  opium,  in  the 
form  of  Dover's  powder,  alone  or  in  combination  with  calomel,  acts 
admirably  in  allaying  the  disturbance  of  the  system. 

Hemorrhages. — Although  opium  possesses  astringent  properties,  and 
is  continually  used  in  checking  profuse  secretion,  it  does  not  seem  to 
exert  any  direct  control  over  bleeding  vessels.     As  a  remedy,  therefore, 


,\  aim  'ones.  -';7.; 

to  arrest  hemorrhage,  it  is  not  to  I":  used;  it  sometimes  does  a  good 
deal  of  harm.  When,  however,  large  quantities  of  blood  have  been 
lost,  certain  effects  of  a  very  serious  character  generally  result,  and  it-  in 
for  the  relief  of  these  that  we  have  recour  e  to  opium,  and  frequently 

with  the  best  effects. 

The  first  of  these  is  the  convulsive  reaction  of  the  vascular  system, 
which  usually  takes  place  alter  considerable  quantities  of  Mood  have 
been  lost.  In  this  condition  of  things  there  is  a  morbid  irritability  of 
the  vascular  and  nervous  systems,  in  consequence  of  which  the  acti 
of  both  become  irregular  and  troublesome.  'Die  heart  beats  violently, 
the  head  throbs,  <fcc.  Now,  to  calm  all  this,  there  is  no  remedj 
valuable  as  opium,  and  it  manifestly  operates  by  its  soothing  and  seda- 
tive influence  on  the  nerves,  secondarily  affecting  the  vascular  system. 

The  second  of  these  is  actual  convulsion  and  spasm,  resulting  from 
the  loss  of  blood.  This  not  unfrequently  takes  place,  either  from 
accidental  hemorrhage  or  from  venesection.  When  it  does  occur,  opium 
is  one  of  the  best  remedies  to  correct  it. 

You  perceive,  then,  that  opium  is  used  in  these  cases,  not  to  arrest 
the  hemorrhage,  but  to  correct  certain  effects  resulting  from  hemor- 
rhage. If  you  keep  this  distinction  constantly  in  view,  it  will  be  a 
guide  of  some  importance  to  you  in  the  use  of  a  remedy  which  I  fear 
is  very  empirically  used  by  many  in  these  cases.  Opium  may,  however, 
be  still  further  useful  in  these  cases,  and  this  is  by  preventing  the 
recurrence  of  hemorrhage.  When  great  vascular  reaction  takes  place 
from  the  loss  of  blood,  there  is  constant  danger  of  a  renewal  of  the 
hemorrhage,  and  the  best  mode  of  obviating  this  is  by  calming  the 
circulation  and  quieting  the  irritability  of  the  nervous  system,  and  in 
this  way  opium  aids  wonderfully  in  conjunction  with  other  remedies  of  a 
directly  astringent  nature,  in  preventing  a  recurrence  of  the  difficulty. 

Diseases  or  the  Brain  and  Nervous  System. — From  the  peculiar 
effects  of  opium  on  the  brain,  it  is  evident  it  is  an  agent  which  must  be 
used  with  great  caution  in  affections  of  this  organ,  and  there  is  none  in 
which  its  use  is  frequently'attended  with  more  serious  consequences. 
As  a  general  rule,  in  all  affections  of  the  brain  attended  with  inflamma- 
tion or  congestion,  opium  is  an  improper  remedy.  Accordingly,  in  cases 
of  phrenitis,  apoplexy,  &c,  it  is  not  to  be  used.  Even  in  these  cases, 
however,  after  suitable  depletion,  and  during  convalescence,  it  may  be 
used  occasionally  with  great  advantage  to  allay  irritability,  quiet  rest- 
lessness, and  promote  sleep. 

In  ^araZysi's  its  use  has  been  universally  reprobated,  and  as  a  geueral 
rule,  unquestionably  it  ought  to  be  resorted  to  with  caution.  Even 
here,  however,  it  may  be  used  under  suitable  conditions  of  the  system. 
Where   the  paralysis  is  not    associated  with  a  plethoric  or  congested 


374  MATERIA   MEDICA   AND   THERAPEUTICS. 

state,  it  is  frequently  very  useful  to  quiet  irritability  and  produce  sleep. 
On  this  subject  the  opinion  of  Heberden  is  valuable.  "  When  I  knew 
no  more  of  physic,"  says  he,  "  than  what  I  had  learned  from  books,  I 
was  very  apprehensive,  as  I  was  taught  to  be,  and  by  plausible  reason- 
ing, that  opium  was  hurtful  in  palsies  aud  apoplexies  ;  for  it  is  supposed 
to  have  the' effect  of  deadening  the  powers  of  the  nerves,  and  therefore, 
must  be  improper  where  we  want  to  enliven  them.  This  hypothesis, 
however  specious,  wants  the  attestation  of  experience.  I  have  met 
with  some,  who,  while  they  were  recovering  from  a  palsy,  used  opium 
plentifully,  and  afterwards  never  passed  a  night  without  taking  twenty 
or  thirty  drops  of  tinct.  opii  for  many  years,  which  practice  did  not 
hinder  them  from  living  very  well,  and  was  supposed  to  assist  them  in 
doing  so.  In  consequence  of  these  examples  I  have  frequently  given  it 
in  paralytic  cases,  when  the  restlessness  seemed  to  require  it,  and  with 
as  much  advantage  as  in  any  other  disease."    (Commentaries,  p.  290.) 

Lsr  Mania.  —  Opium  has  been,  highly  commended  by  some  and 
denounced  by  others.  Whether  it  proves  serviceable  or  not  depends 
entirely  upon  circumstances.  If  it  be  used  while  there  is  great  fulness 
of  habit,  or  where  there  is  active  determination  to  the  brain,  and  where 
the  bowels  are  costive,  it  will  be  sure  to  aggravate  all  the  symptoms. 
As  a  general  rule,  therefore,  in  the  early  stage  of  the  disease,  it  will 
surely  prove  injurious.  In  the  more  advanced  periods,  where  the  sys- 
tem has  been  properly  evacuated  and  reduced,  it  sometimes  proves 
exceedingly  salutary  in  quieting  irritability  and  causing  sleep.  The 
dose  to  produce  these  effects  ought  to  be  large,  otherwise  more  harm 
than  good  results  from  its  use.  Burrows  recommends  a  large  dose  at 
first,  to  be  followed  by  smaller  ones  until  the  desired  effect  is  produced. 
Where  an  anodyne  is  admissible,  he  begins  with  three  grains  of  opium, 
and  repeats  a  grain  every  two  or  three  hours.  He  has  never  in  this 
way  exceeded  twelve  grains,  and  if  sleep  did  not  follow  from  this  he 
has  desisted*     By  others  much  larger  quantities  have  been  given.f 

It  is  an  interesting  fact  connected  with  the  operation  of  opium,  that 
the  insane  are  comparatively  insensible  to  its  effects,  as  they  are  to 
many  other  remedial  agents.  After  the  operation  of  an  emetic,  it  has 
been  found  that  smaller  doses  will  affect  the  system.  (See  Crump  on 
Opium,  p.  288.     Cox  on  Insanity.) 

There  are  two  forms  of  maniacal  disorder  in  which  opium  is  a  remedy 
of  great  value.  The  mania  of  puerperal  women  and  the  mania  resulting 
from  the  too  free  use  of  liquor. 

In  puerperal  mania,  opium  operates  more  kindly  and  beneficially 
than  it  does  in  the  ordinary  forms  of  mania,  and  the  reason  no  doubt  is 

*  Commentaries,  p.  613.  f  Ibid.  p.  612. 


NARCOTICS.  375 

the  peculiar  condition  of  the  system  under  v.  Inch  it  occurs,  IcinLr  more 
favorable  for  obtaining  the  soothing  and  Bedative  effects  of  this  drug. 
Tne  patient  is  debilitated  by  the  various  evacuations  attending  delivery. 
The  mania  is  frequently  dependent  merely  upon  nervous  irritation  and 

debility,  and  in  this  condition  of  the  system  opiates  may  he  '/ivcn  wit.Ii 
great  prospect  of  success.  Even  here,  however,  they  should  not  be 
given  indiscriminately.  If  there  should  he  fulness  of  the  bead,  as  indi- 
cated by  heat  of  the  head,  flushed  face,  &c,  opium  should  not  be  given 
until  this  is  relieved  by  local  bleeding,  purgatives,  cold  to  the  head,  &c. 
After  these  are  removed,  it  may  then  be  given  in  a  full  dose.  l.>r. 
Gooch  recommends  twenty  minims  of  the  sedative  solution  of  Battley, 
repeated  once  or  twice  at  intervals  of  two  hours  unless  sleep  be  induced. 
When  sleep  has  once  been  procured,  small  doses,  such  as  five  or  ten 
minims,  should  be  given  at  intervals  of  six  hours.  If  these  do  not  pro- 
duce sleep  at  night  the  larger  doses  may  be  occasionally  resorted  to. 
Constipation  should  be  obviated  all  this  time  by  suitable  cathartics. 
When  opiates  have  produced  the  desired  effect  in  this  complaint,  they 
should  be  withdrawn  gradually,  diminishing  the  dose  and  lengthening 
the  interval.* 

In  Delirium  Tremens. — In  this  disease  most  enormous  doses  of  opium 
have  been  given,  and  as  a  general  result,  if  profound  and  long  continued 
sleep  follows  their  use,  the  patient  will  recover.  But  here  the  same 
cautions  as  to  the  exact  condition  of  the  system  at  the  time  when  the 
drug  is  administered,  that  have  been  so  often  insisted  on,  are  to  be 
regarded.  If  plethora  and  determination  to  the  brain  exist,  if  the  bow- 
els are  loaded,  the  tongue  foul,  the  skin  dry  and  hot,  opium  will  do  no 
good ;  and  in  delirium  tremens,  it  may  be  laid  down  as  an  almost  uni- 
versal rule  that  where  opium  does  no  good  it  is  certain  to  do  harm. 
In  multitudes  of  these  cases  life  has  been  sacrificed  in  the  vain,  irra- 
tional attempt  to  overwhelm  the  system  by  opium.  When  the  skin  i9 
cool  and  moist,  the  bowels  free,  the  pulse  soft,  and  the  prostration  not 
extreme,  opium  will  often  produce  sleep  and  cure  the  disease.  Where 
prostration  is  extreme,  a  large  dose  of  opium  may  overwhelm  the  sys- 
tem and  induce  fatal  consequences. 

[Peritonitis. — The  use  of  opium  in  peritonitis,  commended  by  Arm- 
strong, has  been  much  extended,  and  with  the  happiest  effects,  by  Prof. 
Clark.  He  gives,  immediately  on  diagnosticating  the  disease,  from  half 
a  grain  to  one  grain  of  morphine,  or  an  equivalent  dose  of  opium,  two 
grains  to  five  grains,  and  repeats  it  every  hour  or  two  till  the  patient  is 
profoundly  narcotised.  The  opium  is  then  continued  in  such  doses  as  to 
keep  up  decided  narcotism,  as  marked  by  contracted  pupil,  respiration  not 
over  twelve  in  the  minute,  deep  sleep,  from  which  the  patient  is  roused 

*  Gooch's  Essays,  p.  152 ;  also  Burrows,  p.  400. 


376  MATERIA   MEDICA   AND   THERAPEUTICS. 

with  some  difficulty ;  in  this  condition  he  is  kept  occasionally  allowing 
a  slight  let  up,  till  the.  pulse  falls,  then  the  opium  must  be  gradually 
diminished  in  dose  and  frequency,  the  practitioner  being  ready  at  tfce 
slightest  hurrying  of  the  pulse  to  plunge  his  patient  again  into  the 
deepest  narcotism.  I  have  tried  this  mode  of  treatment  both  in  puer- 
peral and  idiopathic  peritonitis  with  most  encouraging  results.  In 
puerperal  peritonitis  especially  my  experience  warrants  me  in  preferring 
it  to  any  other  practice.  It  must  be  carefully  watched,,  the  patient 
seen  every  two  to  four  hours.  The  bowels  often  remain  unmoved  for 
ten  days — purges  are  utterly  incompatible  with  this  treatment.] 

Preparations. — The  decoction  of  .poppy  heads  is  a  good  fomentation. 
Poppy  heads  scalded  are  sometimes  added  to  bran,  hops,  and  the  like 
when  used  as  a  poultice,  to  make  it  more  decidedly  anodyne. 

JPulvis  Opii  et  Ipecacuanhas  Compositus. — This  is  commonly  known 
by  the  name  of  Dover's  Powder,  and  is  prepared  by  taking  one  part  of 
.opium  and  ipecac,  each,  and  of  sulphate  of  potassa  eight  parts,  and 
triturating  to  a  fine  powder.  Ten  grains  of  this  contain  one  grain  of 
opium.  This  is  an  excellent  preparation,  and  furnishes  a  striking  illus- 
tration of  the  advantages  of  combining  medicines.  The  ipecac,  renders 
the  opium  more  certain  in  its  action  as  a  sudorific,  and  at  the  same 
time  corrects  to  a  great  extent  the  evil  effects  which  opium  alone  is  apt 
.to  produce  on  the  head.  The  sulphate  is  added  for  the  purpose  of  tri- 
turating more  freely  and  mixing  the  ingredients  more  intimately.  By 
some  it  is  supposed  that  the  general  efficacy  of  the  compound  is  thus 
increased,  inasmuch  as  the  opium  and  ipecac,  alone  will  not  act  pre- 
cisely in  the  same  way  as  when  the  potassa  is  combined. 

Dover's  powder  may  be  used  in  all  cases  where  a  sudorific  anodyne  is 
required.     The  average  close  for  an  adult  is  10  grs. 

Tinctura  Opii,  Tinctura  Thebaica,  commonly  called  Laudanum  or 
Liquid  Laudanum. — This  is  prepared  according  to  the  U.  S.  P.,  by  ma- 
cerating for  fourteen  days  p  iiss  of  opium  in  powder  in  two  pints  of  dilut- 
ed alcohol,  and  then  straining. 

This  tincture  is  of  a  deep  brownish  red  color,  having  the  peculiar 
smell  and  taste  of  opium.  In  this  preparation  about  two  thirds  of  the 
opium  are  dissolved  by  the  alcohol  (water  dissolves  less  than  three- 
sevenths).  The  residuum  consists  of  impurities,  containing  still,  how- 
ever, a  small  proportion  of  morphine.  Pereira  says  he  has  repeatedly 
prepared  morphine  from  the  insoluble  residue  thus  left.  Twenty-five 
drops  (or  thirteen  minims)  are  about  equivalent  to  one  grain  of 
opium. 

The  tincture  of  opium  has  some  important  advantages  over  the  solid 
opium.  It  is  more  speedy  in  its  action.  It  can  be  given  more  conve- 
niently in  minute  doses.     This  is  a  great  advantage  when  an  opiate  is 


narcotics.  877 

required  for  children.     Lastly,  it  can  be  combined  more  readjly  with 
other  medicines. 

Tncompatibles. — Care  should  be  taken  Dot  to  give  laudanum  in  com- 
bination with  ammonia,  soda,  and  potash,  or  their  carbonates,  a  they 
precipitate  the  morphine.  Most  metallic  salts  and  tincture  of  galls  a  o 
decompose  it. 

In  the  use  of  this  article  it  is  important  to  know  that  if  it  be  kepi  for 
any  length  of  time,  and  occasionally  exposed  to  the  air,  it  becomes  thick. 
This  is  owing  to  the  evaporation  of  a  portion  of  the  alcohol,  and  the 
deposition  of  the  opium.  In  this  state  its  strength  is  greatly  increased, 
and  infants  have  frequently  been  destroyed  by  giving  this  even  in  mode- 
rate and  ordinary  doses.*  In  all  cases  the  tincture  should  be  transpa- 
rent. 

2.  Tinctura  Opii  Camphorata. — This  is  the  common  paregoric  elixir. 
This  consists  of  opium,  Benzoic  acid,  oil  of  anise,  liquorice,  clarified 
honey,  camphor,  and  diluted  alcohol. 

Half  an  ounce  of  this  contains  about  one  grain  of  opium. 
This  is  a  mild  and  valuable  preparation  of  opium,  and  unites  the  pro- 
perties of  a  narcotic  with  those  of  an  antispasmodic.  The  principal  use 
of  it  is  to  allay  troublesome  cough.  It  diminishes  the  sensibility  of  the 
bronchial  membrane  to  the  influence  of  cold  air,  checks  profuse  secre- 
tion, and  allays  spasmodic  cough.  Besides  this  it  is  used  to  relieve 
nausea  and  slight  pains  in  the  stomach  and  bowels,  and  in  infants  to 
procure  sleep. 

The  dose  for  an  adult  is  from  3  i  to  3  jv  5  for  a  child,  from  five  to 
twenty  drops,  according  to  the  age. 

Acetated  Tincture  of  Opium. — This  is  prepared  by  rubbing  up  §  ij  of 
opium  with  §  xii  of  vinegar,  and  then  adding  half  a  pint  of  alcohol,  and 
macerating  for  fourteen  days  and  filtering. 

In  this  preparation,  it  is  supposed  that  a  portion  at  least  of  the  meco- 
nate  of  morphine  is  decomposed,  and  acetate  of  morphine  is  formed. 
Pereira,  however,  says  this  is  not  fully  established. 

This  is  a  very  mild  and  valuable  preparation  of  opium.  It  has  all  the 
narcotic  effects  without  producing  the  nausea,  headache,  and  nervous 
disorders,  which  frequently  result  from  the  ordinary  preparations  of  this 
article. 

Ten  minims  or  twenty  drops  are  equivalent  to  gr.  i  of  opium.  This 
preparation  has  been  introduced  into  the  U.  S.  Pharmacopoeia,  as  a  sub- 
stitute for  the  ordinary  black  drop,  and  has  the  great  advantages  of  uni- 
formity and  certainty  in  its  strength. 

4.  Vinum  Opii. — This  is  prepared  by  taking  of  opium  ^ij,  cinnamon 
and  cloves  bruised  each   3  i,  and  macerating  in  a  pint  of  Teneriffe  wine 

*  Ellis's  Formulary.     TJ.  S.  Disp. 


378  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

for  fourteen  days  and  filtering.  This  is  nearly  the  same  as  the  liquid 
laudanum  of  Sydenham.  It  is  about  the  same  strength  as  common 
laudanum,  and  may  be  given  in  the  same  doses.  From  the  aromatics 
with  which  it  is  combined,  it  sits  better  on  the  stomach.  As  a  local 
application,  the  wine  of  opium  is  recommended  in  cases  of  chronic  oph- 
thalmia, two  or  three  drops  being  introduced  under  the  eyelids  daily. 

Morphine — Modes  of  obtaining  it. — There  are  various  modes  of  ob- 
taining morphine  from  opium.  The  process  recommended  in  the  U.  S. 
Pharmacopoeia  is  the  following  :  Sliced  opium  is  first  macerated  and 
worked  up  with  water  for  a  suitable  length  of  time,  then  filtered,  and  to 
this  added  a  mixture  of  alcohol  and  water  of  ammonia,  when  the  mor- 
phia is  deposited  in  crystals.  To  purify  these,  they  are  boiled  in  alco- 
hol, and  filtered  through  animal  charcoal.  In  this  process  the  water 
extracts  the  meconate  of  morphine.  This  is  decomposed  by  the  ammo- 
nia, while  the  alcohol  seems  to  suspend  the  coloring  matter  and  render 
the  crystals  purer. 

Quantity  of  Morphine  in  Opium. — This  has  already  been  alluded  to. 
As  then  stated,  it  varies  not  merely  in  the  different  kinds  of  opium,  but 
in  different  samples  of  the  same  kind.  The  Smyrna  opium  contains  the 
most,  varying  from  nine  per  cent,  or  less  to  fourteen,  the  Constantinople 
only  one  half,  and  the  Egyptian  five  sevenths  of  the  quantity  obtained 
from  the  Smyrna  opium.  Dr.  Christison  obtained  from  half  a  pound  of 
the  best  Turkey  opium  3|-  drachms  of  morphine,  and  two  drachms  of 
narcotine.  M.  Dublanc  procured  as  the  mean  of  six  trials  eight  per  cent, 
of  morphine  and  three  per  cent,  of  narcotine. 

Properties. — When  pure,  morphine  is  in  small,  beautifully  white 
crystals.  The  primary  form  of  the  crystal  is  a  right  rhombic  prism.  It 
has  a  bitter  taste,  but  is  destitute  of  smell.  In  cold  water  it  is  insoluble 
— boiling  water  dissolves  about  one  part  in  one  hundred.  It  is  soluble 
in- forty  parts  of  cold  anhydrous  alcohol,  and  thirty  parts  when  boiling. 
In  ether,  it  is  nearly  insoluble.  It  turns  vegetable  blues  to  green,  and 
combines  with  the  acids  forming  crystallizable  salts — nitric  acid  turns 
it  red. 

It  consists  of  oxygen,  hydrogen,  carbon,  and  nitrogen. 

Effects. — Although  the  most  powerful  principle  of  opium,  morphine  is 
not  used  in  medicine  in  its  simple  alkaline  state.  Owing  to  its  great 
insolubility,  it  is  by  no  means  certain  and  constant  in  its  effects,  depend- 
ing for  its  activity,  no  doubt,  upon  the  degree  and  kinds  of  acid  it  meets 
with  in  the  stomach.  In  combination  with  acids  it  is,  however,  very 
soluble,  and  it  is  only  in  the  form  of  salts,  therefore,  that  it  is  used.  Of 
these,  the  ones  used  are  the  acetate,  sulphate,  and  hydrochlorate. 

Acetate  of  Morphine. — This  is  prepared  by  dissolving  morphine  in 


NARCOTICS.  379 

dilute  acetic  acid,  and  then  evaporating  the  solution  to  drynei  .  Acetate 
of  morphine  crystallizes  in  Blender  needles,  but  from  its  deliquescent 
nature  is  seldom  obtained  in  a  crystalline  form.     It  is  generally  in  the 

form  of  a  powder.  It  is  readily  dissolved  in  water,  especially  where, 
there  is  an  excess  of  acid.     In  alcohol  it  is  less  soluble  than  in  water, 

It  may  be  given  in  pill  or  volution.  One  sixth  of  a  grain  is  about 
equivalent  to  a  grain  of  opium. 

Sulphate  of  Morphine. — This  is  prepared  by  dissolving  morphine 
in  diluted  sulphuric  acid.  ]>y  evaporating  the  solution,  crystals  are 
formed.  These  are  small,  white,  and  feathery,  resembling  very  much  in 
appearance  the  sulphate  of  quinine.  They  can  easily  be  distinguished, 
however,  by  adding  concentrated  nitric  acid.  This  turns  the  sulphate  of 
morphine  red,  but  not  the  sulphate  of  quinine.  Sulphate  of  morphine 
is  soluble  in  twice  its  weight  of  boiling  water,  and  if  pure,  is  easily  and 
readily  soluble  in  cold  water. 

As  found  in  the  shops,  and  especially  if  obtained  from  France,  it  is  not 
always  entirely  soluble  in  water.  This  is  owing  sometimes  to  adultera- 
tions, but  oftener  to  its  containing  some  uncombined  morphine,  owing 
to  the  mode  of  preparation.  This  is  corrected  by  the  addition  of  a 
little  acid. 

The  sulphate  may  be  given  in  pill  and  solution.  One  sixth  of  a  grain 
is  equal  to  a  grain  of  opium. 

Solution  of  Sulphate  of  Morphine. — It  is  important  to  know  that 
there  are  two  solutions  of  this  salt  of  very  different  strength — that  of 
Magendie,  and  that  of  the  United  States  Pharmacopoeia. 

Magendie's  contains  sixteen  grains  to  5  j  of  water.  Of  this,  five  drops 
are  equivalent  to  one  sixth  of  a  grain  of  the  salt. 

U.  S.  Pharmacopoeia  contains  one  grain  to  §  j  of  water — of  this,  eighty 
drops  are  equal  to  one  sixth  of  a  grain. 

Hydrochlorate  of  Morphine. — This  is  preparad  by  saturating 
the  pure  base  with  hydrochloric  acid,  and  crystallizing. 

This  is  a  colorless,  inodorous,  bitter  salt,  crystallizing  in  plumose 
acicular  crystals  ;  it  is  soluble  in  sixteen  to  twenty  times  its  weight  of 
water.     It  is  also  soluble  in  alcohol. 

The  strength  of  this  is  the  same  as  the  two  preceding.  This  is  con- 
sidered by  many  as  the  best  salt  of  morphine  for  medicinal  purposes.  To 
the  acetate  it  is  preferable,  as  it  is  more  easily  obtained  in  crystals,  and 
is  not  subject  to  decomposition  during  its  preparation. 

Effects  of  the  Salts  of  Morphine. — In  their  action  on  the  system 
they  do  not  differ.  They  produce  the  same  effects,  and  may  be  given  iu 
the  same  doses.     Compared  with  opium  and  its  ordinary  preparations, 


380  MATERIA   MEDIC  A   A2TO   THERAPEUTICS. 

they  differ  in  many  important  particulars.  While  they  produce  the 
anodyne  and  narcotic  effects  of  opium,  they  are  less  stimulating — they 
are  less  sudorific — they  do  not  have  the  same  tendency  to  produce  con- 
stipation, and  they  are  less  apt  to  leave  headache,  nausea,  dryness  of  the 
tongue,  and  other  unpleasant  effects.  In  all  cases,  therefore,  where  the 
object  is  to  allay  pain  and  nervous  irritation,  arid  to  produce  sleep,  they 
are  preferable  to  opium.  Where  the  object  is  to  get  an  astringent  effect 
on  the  mucous  membrane,  or  a  stimulant  effect  on  the  system,  opium  is 
to  be  preferred.  In  cases  of  chronic  irritation,  where  the  daily  repeti- 
tion of  an  anodyne  is  called  for,  the  morphic  salts  are  invaluable. 
Another  advantage  attending  them  is,  that  they  may  be  applied  ender- 
mically. 


The  Hyoscyamus  Niger,  growing  two  or  three  feet  high,  with  large 
sea-green  leaves,  and  straw-colored  flowers.  The  whole  plant  has  a 
dark,  lurid  appearance.  It  is  found  in  every  part  of  Europe,  and  extends 
to  Asia.  In  this  country  it  is  supposed  to  have  been  naturalized,  from 
the  fact  of  its  being  found  only  in  the  vicinity  of  houses,  road  sides,  in 
old  fields,  gardens,  <fec.  It  is  only  met  with  in  the  Northern  and  Eastern 
States,  from  Nova  Scotia  to  Rhode  Island,  and  extending  back  to  New 
York  and  Canada.  In  Ohio  and  Pennsylvania  it  is  very  rare,  and  at  the 
South  quite  unknown.     {Rafinesque 's  Flora.) 

e  Every  part  of  this  plant  is  possessed  of  activity.  The  only  part,  how- 
ever, that  is  used  officinally  in  this  country  is  the  leaves.  When  fresh, 
these  have  a  mucilaginous  and  slightly  acrid  taste,  and  when  bruised  emit 
a  strong,  foetid,  and  narcotic  odor.  Thrown  on  the  fire  they  burn  with  a 
noise  as  if  they  contained  nitre,  and  give  out  a  strong  smell.  By  drying 
the  leaves  lose  both  their  taste  and  smell.  Diluted  alcohol  extracts  all 
their  virtues. 

The  active  principle  of  the  henbane  is  Hyoscyamine,  a  vegetable  alkali, 
obtained  by  Brande  from  the  seeds  and  the  herb — resembles  in  its  pro- 
perties very  much  atropine.  Besides  this  an  empyreumatic  oil  has  been 
obtained  from  it  by  destructive  distillation,  its  chemical  properties 
identical  with  those  of  the  empyreumatic  oil  of  digitalis,  and  is  a  power- 
ful narcotic  poison. 

Effects. — In  some  respects  henbane  resembles  opium  in  its  action  on 
the  system.  In  moderate  doses,  it  first  slightly  quickens  the  pulse ;  after 
this,  diminishes  sensibility,  calms  the  system,  and  eventually  produces 
sleep.  In  larger  doses,  general  insensibility  speedily  comes  on,  there  is 
profound  sleep,  dilatation  of  the  pupil,  and  in  some  cases  delirium 
accompanied  with  a  full  pulse,  indicating  great  cerebral  congestion. 

Opium  and  henbane  resemble  each  other  in  the  power  of  diminishing 


na"k<;oh< 

sensibility  and  calming  the  system,  inducing  Ble<  p  and  ad  ing  on  the 
Id  some  important  respects,  however,  they  differ.     I.   [n  its  prin 
operation  and  in  small  doses,  benbane  is  not  so  stimujal 
2.  It  does  not  constipate  the  bowels,  but  rather  relaxes  them.    ■';.  Opium 
lessens  tlie  urinary  secretion,  while  benbane  increases  it.     i.  On  thi 
organ  of  vision  th~i  effect  of  the  two  differs— opium  contracts,  lien' 
dilates  the  pupil.    The  same  effect  is  produced  by  the  local  application 
of  henbane  to  the  conjunctiva.     As  ;i  remedial  agent  benbane  has  raanj 
advantages  over  opium,  and  may  be  used  as  a  substitute  for  that  article 
where  it  does  not  agree  with  the  patient.     It  calms  the  system,  allays 
pain,  and  produces  sleep,  at  the  same  time  it  does  not  shut  up  the  ai 
tions.     It  may  be  given  in  all  irritable  states  of  the  nervous  system  with 
advantage.     It   is  commonly,  too,  combined   with   cathartics  to  obviate 
their  irritating  effects  without  lessening  their  cathartic  power. 

Mode  of  Administration. — Two  extracts,  a  watery  and  an  alcoholic, 
are  officinal, .as  is  the  tincture.  Dose  of  the  extracts  grs.  i  to  ij.  Of 
the  tincture   3  i  to   3  ij. 

[One  grain  of  extract  hyoscyamus  combined  with  one  of  camphor  makes 
the  best  anodyne  pill  for  the  use  of  females  subsequent  to  confinement  with 
which  I  am  acquainted.  I  direct  a  pill  at  bedtime,  and  another  every 
hour  till  sleep  is  obtained.     Rarely  are  more  than  three  required. — Ed.] 


LACTUCARIUM. 

This  is  a  peculiar  substance  obtained  from  the  Lactuca  sativa,  or 
garden  lettuce,  a  plant  extensively  cultivated  both  in  this  country  and  in 
Europe.  The  leaves  and  stem  of  the  plant  abound  in  a  juice  which  has 
a  milky  appearance,  but  on  exposure  to  the  atmosphere  it  concretes,  and 
becomes  of  a  brownish  color,  resembling  opium.  This  is  the  lactuca- 
rium,  by  the  French  called  thcridace. 

JP reparation. — The  mode  originally  suggested  by  Mr.  Young  of  Edin- 
burgh, for  obtaining  it,  is  the  following.  The  top  of  the  stem  is  cut  off 
when  the  plant  is  in  flower  about  a  foot  above  the  ground,  and  the 
juice  which  exudes  from  the  cut  surface  is  absorbed  by  means  of  a  moist 
sponge,  from  which  it  is  again  squeezed  into  a  proper  vessel  and  inspis- 
sated. As  soon  as  the  cut  surface  ceases  to  yield  the  juice,  another 
slice  is  to  be  taken  off,  and  this  to  be  continued  as  long  as  juice  con- 
tinues to  be  poured  out.  On  standing,  it  concretes  and  changes  to  a 
brown  color. 

Properties. — In  its  taste  and  smell,  lactucarium  bears  a  strong  resem- 
blance to  opium.  It  is  soluble  both  in  water  and  in  alcohol.  At  one 
time  it  was  supposed  to  contain  morphine.  Caventou,  Dublanc,  and 
Gauzel,  in  their  analysis  of  it,  could  discover  no  trace  of  this  principle. 


332  MATERIA   MEDICA   AND   THERAPEUTICS. 

Physiological  Effects. — In  its  action  on  the  animal  economy,  lactuca- 
rium  resembles  opium,  impairing  the  sensibility  of  the  system  and  induc- 
ing sleep.  It  is  more  mild,  however,  in  its  operation,  and  does  not  leave 
behind  it  any  of  the  unpleasant  effects  which  so  frequently  follow  the  use 
of  opium,  such  as  stupor,  headache,  and  nausea.  Unlike  ©pium  it  does 
not  constipate  the  bowels,  and  according  to  the  experiments  of  Dr.  Fran- 
cois, it  acts  on  the  circulation  as  a  direct  sedative.  In  a  number  of  cases 
in  which  he  gave  it  the  pulse  was  reduced  from  seven  to  twelve  beats  in 
the  minute. 

Mode  of  Administration. — Given  in  pill,  dose  grs.  x_to  3i.  Tincture? 
3  i  to   3  iij-     It  is  very  little  used. 


HUMULUS    LUPULU3. 

This  is  the  common  hop,  a  plant  growing  native  both  in  Europe  and 
America.  In  both  also  it  is  extensively  cultivated.  In  different  parts 
of  the  United  States  it  is  found  growing  spontaneously.  The  part  of 
the  plant  used  are  the  strobiles.  They  are  picked  when  the  plant  is 
scarcely  ripe,  and  gradually  and  carefully  dried.  Five  pounds  of  fresh 
hops  make  about  one  pound  dried.  \ 

Properties. — The  strobiles  of  the  hop  consist  of  thin  scales  of  a 
greenish  yellow  color;  they  have  a  strong,  fragrant,  and  somewhat  nar- 
cotic odor,  and  a  bitter,  aromatic  taste.  The  surface  of  these  scales  is 
covered  with  a  yellow  powdery  substance,  which  is  easily  separated  by 
sifting  the  hops  through  a  common  sieve.  It  is  supposed  to  be  peculiar 
to  the  female  plant,  and  to  be  secreted  by  the  nectaria.  To  this  pow- 
der the  name  of  Lupulin  has  been  given.  It  is  in  the  Lupulin  that  the 
active  principles  of  the  hop  chiefly  reside. 

The  strobiles  yield  their  virtues  to  boiling  water,  alcohol,  and  ether. 
By  long  boiling,  they  lose  their  aromatic  flavor. 

Physiological  Effects. — As  a  narcotic  the  powers  of  the  hop  are  feeble 
and  it  is  not  to  be  compared  with  opium  and  other  articles  of  this  class. 
Nevertheless,  it  is  capable  of  lessening  sensibility,  assuaging  pain,  and 
inducing  sleep.  It  differs  from  opium  in  being  tonic  to  the  digestive 
organs  and  laxative  to  the  bowels,  hence  it  is  not  so  apt  to  produce 
headache  as  opium.  In  its  general  properties  it  resembles  more  nearly 
hvoscyamus,  and  may  frequently  be  used  with  great  advantage  as  a 
substitute  for  more  potent  narcotics. 

Mode  of  Administration. — 1.  Substance. — In  the  form  of  powder, 
twenty  grains  may  be  given  to  an  adult.  In  the  experiments  made  by 
Bryaily,  this  caused  nausea  and  catharsis  without  affecting  the  pulse. 

2.  Infusion. — Half  an  ounce  of  the  hops  in  a  pint  of  boiling  water. 
Of  this  two  or  three  ounces  may  be  taken  three  or  four  times  a  day. 


nau<  ones, 

3,  Tincture. — Thia  is  the  most  common  form  of  using  it.     The  do 

is  from   3,j  to  3  ij. 

Lupulin. — This,  as  already  ;  t..-i t < •< I,  is  ;i  peculiar  substance  obtained 
from  the  hop.    Tt  is  in  the  form  .of  small,  Bhiny,  yellowish  grains,  ba 
an  aromatic  smell  and  bitter  ta  te. 

Chemical  Properties. — According  to  the  analysis  of  Chevalier  and 
Payen,  lupulin  contains  resin,  volatile  oil,  ami  a  peculiar  hitter  principle. 
It  is  to  this  hitter  principle  that  ii  has  been  proposed  to  restricl  the 
name  of  lupulin.  Lupulin  is  soluble  in  water,  alcohol,  and  ether,  and 
to  all  these  substances  imparts  its  bitterness. 

Physiological  Effects. — In  its  general  operation,  lupulin  resembles  the 
hop  itself,  acting  as  a  tonic  and  narcotic. 

Mode  of  Administration. — 1,  Substance. — In  doses  of  from  six  to 
twelve  grains  made  into  pills. 

2.  Tincture. — Made  by  digesting  f  ij  of  lupulin  in  a  pint  of  alcohi  L 
Of  this  the  dose  is  from  one  to  two  drachms. 

3.  Hop  Pillow. — This  is  frequently  resorted  to  as  a  soporific,  ami 
has  undoubtedly  some  force  in  controlling  restlessness.     It  was  rendered 

fashionable  in  England  towards  the  close  of  the  last  century,  from  the 
circumstance  that  it  was  prescribed  by  Willis  with  great  apparent  benefit 
to  Georo-e  III. 


CONIUM    MACULATUM. 

This  is  the  hemlock,  and  was  formerly  known  by  the  name  of  ciewta. 
It  is  a  large  umbelliferous  plant,  indigenous  in  Europe,  but  now  natu- 
ralized and  growing  in  great  abundance  in  this  country.  It  has  a 
striated  stalk  from  three  to  five  feet  high,  with  purple  spots  upon  it. 
These  characters  of  the  stem  distinguish  it  from  other  plants  resembling 
it.  In  this  country  it  is  found  iu  old  fields,  near  roads  and  fences,  and 
flowers  from  June  to  August.  The  whole  plant  has  a  disagreeable 
smell,  generally  compared  to  the  urine  of  the  cat.  The  part  used  in 
medicine  is  the  leaves. 

Properties. — The  leaves  are  of  a  beautiful  green  color.  "When  dried 
they  lose  somewhat  of  their  disagreeable  smell,  though  they  still  retain 
a  strong  narcotic  odor,  and  have  a  slightly  bitter  and  nauseous  taste. 
The  fresh  leaves  are  supposed  to  contain  both  a  narcotic  and  an  acrid 
principle.  By  drying,  the  latter  is  dissipated,  while  the  former  under- 
goes no  change.  This  process,  therefore,  improves  their  medicinal 
virtues.  When  pulverized,  which  is  readily  done,  the  powder  should 
retain  the  beautiful  green  color  of  the  leaves,  and  with  this  the  peculiar 
odor  of  the  plant     It  is  important  to  recollect  that  exposure  to  light 


384  MATERIA   MEDICA  AND  THERAPEUTICS. 

dissipates  the  color,  and  with  it  the  virtues  of  the  article.  It  should, 
therefore,  always  be  kept  in  a  dark  situation. 

Chemical  Composition  and  Properties. — According  to  the  anatysis  of 
Brande,  conium  contains  resin,  albumen,  coloring  matter,  an  odorant 
volatile  oil,  salts,  and  a  peculiar  alkaline  principle,  to  which  the  name 
of  coneine  has  been  given.  By  others  it  is  called  cicutine.  The  most 
appropriate,  however,  is  eonine. 

Effects. — These  differ  with  the  dose.  In  very  small  doses,  it  may  be 
continued  for  a  long  time  without  producing  any  effect  either  upon  the 
digestive  organs  or  upon  the  constitution  at  large.  When  a  full  dose  is 
given,  the  following  effects  show  themselves :  giddiness,  a  sense  of  ful- 
ness in  the  eyes,  feeling  as  if  they  were  pushed  from  their  sockets,  slight 
sickness  at  the  stomach,  dryness  of  the  throat  and  fauces,  together  with 
a  trembling  agitation  of  the  whole  body  and  impaired  muscular  power. 
Along  with  these  there  are  generally  one  or  two  loose  evacuations.  If 
given  in  doses  a  little  smaller,  its  most  obvious  and  striking  operation 
on  the  system  is  that  of  lessening  sensibility,  allaying  pain,  and  promot- 
ing rest.  On  the  circulation,  conium  produces  no  marked  effect.  It 
differs  from  opium  in  not  constipating  the  bowels,  nor  creating  thirst, 
nor  leaving  headache  behind  it. 

Modifying  Circumstances. — In  the  whole  range  of  the  materia  medica, 
there  is  perhaps  no  article  which  differs  so  much  in  its  ordinary  effects 
as  conium,  so  much  so  indeed  as  to  have  given  rise  to  the  most  contra- 
dictory accounts  in  relation  to  its  use  in  various  diseases.  Abundant 
evidence  of  this  fact  will  be  found  by  consulting  the  observations  of  those 
who  have  treated  of  this  article.  In  a  practical  point  of  view  it  is  im- 
portant to  appreciate  the  causes  of  this  discrepancy,  and  they  are  mainly 
two — a  difference  in  the  strength  and  purity  of  the  article,  and  a  differ- 
ence in  the  mode  of  using  it. 

1.  Of  the  Strength  and  Purity  of  the  Article. — As  found  in  the  shops, 
the  preparations  of  conium  vary  greatly.  This  fact  was  noticed  so  long 
ago  as  the  time  of  Dr.  Cullen.  He  states  that  he  frequently  found  the 
extract  which  was  imported  from  Vienna,  a  perfectly  inert  substance. 
The  same  thing  has  also  been  observed  by  Dr.  Jackson,  of  Boston,  in 
relation  to  that  which  is  imported  into  this  country  from  England. 

2.  Difference  in  the  mode  of  using  it. — This  is  another  circumstance 
which  may  aid  us  in  accounting  for  the  discrepancy  of  testimony  in  rela- 
tion to  the  effects  of  this  agent.  Some  physicians,  fearful  of  the  effects 
produced  by  this  powerful  article,  have  given  it  in  doses  so  small,  or 
introduced  it  so  slowly,  that  the  system  never  properly  felt  the  effects 
of  it.  While  others,  commencing  with  too  large  doses,  abandoned  the 
medicine  at  once,  in  consequence  of  the  violent  effects  which  it  occa- 
sioned. There  is  no  doubt  that  in  both  these  ways  the  reputation  of 
conium  has  greatly  suffered.     It  becomes,  then,  a  matter  of  importance 


NAKC0TTC8.  885 

to  know  how  far  it  should  be  carried  so  us  to  secure  its  beneficial  effi 
to  the  fullest  extent.  As  a  general  rule,  no  good  is  to  be  derived  from 
it  unless  it'produces  some  sensible  effect  on  the  nervous  system,  as  mani- 
fested by  giddiness  and  nausea.  As  conium  differs  so  much  in 
strength,  the  safest  plan  is  to  begin  with  a  small  dpse,  w  gr.  j,  to  I": 
increased  every  day  until  these  effects  are.  produced.  As  soon  as  t his 
takes  place,  it  should  be  discontinued  until  they  subside,  and  then  as 
large  doses  should  be  persisted  in  as  can  be  borne  without  reproducing 
thetn. 

Mode  of  Administration. — 1.  Powder. — Of  this  the  average  dose  is 
about  three  or  four  grains.  This  is  the  most  certain  form  in  which  it 
can  be  used  if  freshly  powdered,  but  it  soon  becomes  inert. 

2.  Extract. — This  is  prepared  by  inspissating  by  a  gentle  heat  the 
juice  of  the  fresh  leaves  to  a  proper  consistence.  According  to  M.  Brande 
100  lbs.  weight  of  the  leaves  yield  from  three  to  five  pounds  of  the 
extract.  To  be  good,  this  should  have  a  clear  olive  color,  a  foetid  odor, 
and  a  bitterish  saline  taste.     The  average  dose  is  about  five  grains. 

3.  Tincture. — This  is  a  <xood  form  of  using  it.  The  dose  is  from  half 
a  drachm  to  a  drachm. 

Diseases  in  which  the  Conium  has  been  used. — Notwithstand- 
ing what  may  have  been  said  to  the  contrary,  if  the  article  be  really 
good,  and  if  it  be  used  to  a  sufficient  extent  to  produce  its  specific  effects, 
there  can  be  no  question  that  in  many  cases  Conium  is  a  valuable 
remedy.  Although  known  to  the  ancients,*  and  used  as  an  external 
application,  it  does  not  appear  to  have  been  used  as  a  medicine  internally, 
until  about  the  middle  of  the  last  century. 

Cancer,  Scrofulous  and  Malignant  Ulcers. — These  were  the  diseases 
in  which  Conium  was  first  used  by  Storck,  and  its  virtues  particularly 
lauded.  As  might  readily  be  supposed  from  the  character  of  these  dis- 
eases, subsequent  experience  by  no  means  confirmed  the  high  character 
given  of  this  article  by  him ;  although  it  has  established  the  fact  of  its 
affording  a  certain  degree  of  benefit  even  in  these  intractable  diseases. 
In  genuine  cancer,  said  to  have  been  cured  by  Storck  with  it,  abundant 
evidence  has  shown  that  nothing  is  to  be  expected  from  it.  Alibert 
reports  that  of  upwards  of  100  cases  of  cancer  of  the  uterus  and  other 
parts,  which  were  treated  with  this  remedy  at  the  hospital  of  St.  Louis, 
not  one  was  cured.  But  though  it  is  incompetent  to  a  cure  of  genuine 
cancer,  yet  it  is  not  without  benefit  that  it  has  been  used  even  here. 
Dr.  Eutty  states,  that  although  he  never  knew  a  single  case  of  cancer 

*  By  the  Greeks  it  was  used  as  a  poison ;  and  it  is  this  vrhich  is  supposed  to 
have  been  the  article  given  to  those  eminent  men  of  antiquity,  Phocion  and 
Socrates,  when  they  were  condemned  to  an  ignominious  death  by  their  unjust 
countrymen. 


386  MATERIA   MEDIC  A    AND   THERAPEUTICS. 

cured  by  it,  yet  in  a  great  number  of  cases  it  retarded  tbe  progress  of 
the  disease,  "lessened  the  tumors,  alleviated  the  pain,  mended  the  dis- 
charge, changing  it  from  a  thin,  ichorous,  and  foetid  condition  to  one 
more  like  a  laudable  pus,  and  disposing  the  parts  to  heal."* 
■  In  scrofulous  tumors  and  ulcers  it  has  been  of  still  greater  advantage  ; 
and  numerous  cases  are  reported  in  which,  under  its  use,  they  have  been 
cured.f  In  painful  tumors  and  ill-conditioned  ulcers,  not  specific,  it  has 
also  been  used  with  great  advantage. 

Upon  the  whole,  the  result  of  experience  in  relation  to  conium  in 
the  preceding  affections  seems  to  be,  that  although  possessed  of  no 
power  to  cure  those  of  a  specific  character,  yet  even  in  these,  by  relieving 
pain  and  allaying  general  and  local  irritability,  it  renders  the  patient 
more  comfortable,  improves  the  character  of  the  discharge,  and  retards 
the  progress  of  the  disease.  While  in  those  which  are  not  of  a  specific 
character,  it  places  the  system  in  a  condition  the  most  favorable  to  a 
cure. 

Syphilis. — In  certain  forms  of  this  disease  conium  has  been  used  with 
benefit.  By  Hunter  it  is  recommended ;  and  in  certain  conditions  of 
indolent  buboes  he  speaks  of  it  as  one  of  the  best  remedies.^  Cullen, 
too,  speaks  of  it  as  in  many  cases  of  syphilis  proving  a  valuable  adjuvant. 
In  syphilitic  chancres  of  an  irritable  character,  "conium  given  in  very 
small  doses  will  often  do  much  good." 

Neuralgia. — In  this  disease  the  conium  was,  I  believe,  first  recom- 
mended by  Dr.  Fothergill  ;§  and  by  him  several  cases  are  recorded  in 
which  it  was  used  with  success.  In  the  hands  of  others  since  his  time, 
it  has  by  no  means  sustained  its  reputation. 

Pulmonary  Consumption. — In  this  disease  conium  may  be  used  with 
much  advantage.  By  Dr.  Paris,  especially,  it  is  lauded  in  the  highest 
terms.  Like  every  other  remedy  it  is,  however,  only  palliative.  That 
it  tranquillizes  pulmonary  irritation  in  a  remarkable  manner  is  certain ; 
but  that  it  can  effect  a  cure,  as  Dr.  Paris  intimates,  is  expecting  too  much 
from  it.  He  gives  it  in  doses  of  five  grains  of  the  extract  three  times  a 
day,  to  be  continued  till  the  specific  effects  of  the  article  are  produced. || 
He  recommends  the  following  prescription  : 

IJ.  Ext.  conii 

Ext.  hyoscyam.  aa  3ij. 

Mucilago  acacise  *  3  ij. 
Tere  et  adde 

*  Med.  Obs.  and  Inq.  vol.  iii.  p.  234. 

f  Boyle,  vol.  iii.  p.  620.  See  Eberle's  Practice.  Med.  Obs.  and  Inq.  vol.  iii. 
p.  284. 

%  On  the  Venereal,  p.  260.     Bell,  vol.  ii.  p.  234.     Cullen,  vol.  ii.  p.  189. 
§  Obs.  and  Inq.  vol.  v.  ||  On  Diet,  pp.  199,  200. 


NATirOTICS. 

Liijiioris  ammoniae  acetatis  f  i. 
,\i|.  purse  §  ivss. 
Vin.  ipecac.   3  i. 
Syrupi  rlwead.    3  ij. 
Ft  mistura,  dc  qua  sum  ant  ur  cocb  max.  ter  in  die. 

In  the  New  York  Hospital  I  Lave  used  the  inhalation  of  tlic  saturat- 
ed tincture  of  conium  with  iodine,  according  to  Scudamore's  prescrip- 
tion, with  great  benefit.  It  certainly  relieved  the  cough  and  irs^ened 
the  expectoration,  and  altogether  made  the  patients  more  comfortable. 

Chronic  Rheumatism. — Here  it  is  also  a  remedy  of  value.  J  )r.  '1  hom- 
son  says  he  has  seen  it  produce  more  beneficial  effects  in  chronic  sciatica 
than  any  other  medicine.*  In  a  case  of  this  kind  in  the  N' ••>'.  York 
Hospital,  the  disease  which  has  resisted  a  great  variety  of  remedies 
yielded  readily  to  the  conium,  in  grain  doses  repeated  every  two  hours. 
It  is  also  used  and  with  great  benefit  in  syphilitic  rheumatism. 


ATROPA    BELLADONNA. 

This  is  the  deadly  nightshade,  a  perennial  plant  indigenous  in  Great 
Britain.  It  grows  in  woods  and  shady  places,  and  is  also  frequently  culti- 
vated in  gardens.  It  has  a  thick  root  with  three  or  four  stalks  branch- 
ing from  it,  and  growing  to  the  height  of  from  three  to  five  feet.  Its 
flowers  are  of  reddish  color  and  bell-shaped.  It  bears  beautiful  berries 
of  a  large  size  and  purple  color.  The  whole  plant  is  poisonous,  and  the 
berries  have  frequently  proved  fatal.  The  part  generally  used  in  medi- 
cine is  the  leaves. 

Properties. — When  fresh,  the  leaves  have  a  faint  narcotic  smell, 
which  they  lose  by  drying,  without  having  their  active  properties  at 
all  impaired.     Their  taste  is  subacrid  and  slightly  nauseous. 

Chemical  Properties. — According  to  the  analysis  of  Mr.  Brande,  bel- 
ladonna contains  an  active  principle  of  an  alkaline  character.  This  is 
afropme,  and  exists  in  combination  with  malic  acid.  Besides  this  it 
contains  a  green  resin,  wax,  starch,  gum,  lignin,  albumen,  and  various 
salts.  Both  water  and  alcohol  dissolve  the  active  principles  of  bella- 
donna. 

Atropine. — This  substance  is  in  needle-like  crystals  of  a  brilliant  white 
color,  without  taste  or  smell ;  almost  insoluble  in  water  and  hi  cold 
alcohol,  but  very  soluble  in  boiling  alcohol.  In  ether  and  oil  of  turpen- 
tine also  insoluble.  It  unites  with  the  acids,  forming  crystallizable  salts, 
and  seems  to  possess  a  greater  neutralizing  power  than  any  of  the  vege- 
table alkalies. 

*  Mat.  Med.  vol.  i.  p.  5T5. 


38S  MATERIA  MEDIC  A   AND   THERAPEUTICS. 

Effects. — These  differ  with  the  dose.  In  very  small  doses,  no  sensi- 
ble effect  is  produced,  with  the  exception  perhaps,  in  some  cases,  of  a 
dilatation  of  the  pupils.  In  these  doses  the  action  of  this  agent  is  proba- 
bly in  a  great  measure  local.  In  larger  doses,  such  as  it  is  generally  given 
in  medicine,  the  most  marked  effects  are  a  sense  of  fulness  about  the  head, 
dilatation  of  the  pupil,  more  or  less  dimness  of  the  vision,  with  a  sense 
of  dryness  and  constriction  of  the  throat,  accompanied  frequently  with 
a  difficulty  of  swallowing.  On  discontinuing  the  use  of  the  article,  these 
effects  speedily  disappear.  On  the  vascular  system  no  marked  effect  is 
produced.  On  the  secretions  and  excretions  it  produces  little  effect, 
although  by  some  it  is  supposed  to  increase  the  secretion  of  urine.  Of 
all  the  effects  produced  by  belladonna,  the  most  curious  is  that  of  dilat- 
ing the  pupil.  This  effect  will  follow,  whether  taken  internally,  applied 
around  the  eye,  or  to  a  wound.  When  taken  internally,  so  as  to  affect 
the  pupil,  the  sight  also  is  much  obscured.  Applied  externally,  it  gene- 
rally dilates  the  pupil  without  affecting  the  sight.  This,  however,  is  not 
invariably  the  case.*  The  dilatation  comes  on  about  an  hour  after  the 
application,  and  passes  off  in  the  course  of  two  or  three  days,  if  the  use 
of  the  article  be  discontinued.  In  poisonous  closes  it  produces  dryness 
of  the  throat,  vertigo,  dilatation  of  the  pupil  with  obscured  vision,  and 
a  peculiar  delirium  resembling  intoxication.  This  is  accompanied  gene- 
rally with  excessive  and  ungovernable  laughter,  sometimes  with  constant 
talking,  and  occasionally  with  a  total  loss  of  voice.  After  continuing 
some  hours,  this  is  succeeded  by  stupor,  slight  agitations  of  the  muscles 
without  regular  convulsions,  and  finally  death.  st, 

From  the  foregoing  it  would  appear  that  belladonna  makes  a  peculiar 
impression  upon  the  nervous  system,  lessening  sensibility  and  irritability. 
This  is  more  especially  manifested  in  the  throat  and  the  eye,  upon  both 
of  which  it  produces  transient  paralytic  effects.  It  is  accordingly  used 
in  medicine  with  the  view  of  allaying  pain  and  spasm,  and  obtaining  its 
peculiar  effects  upon  the  organ  of  vision. 

Modes  of  Administration. — Powder — made  from  the  dried  leaves,  is 
the  most  uniform  in  its  strength,  and  is  therefore  preferable  on  this 
account  to  the  other  preparations.  The  dose  to  begin  with  is  about  one 
grain,  to  be  given  once  or  twice  a  day,  and  increased  gradually  until  the 
specific  effects  of  the  article  begin  to  show  themselves.  To  children 
one  eighth  of  a  grain  is  sufficient  as  a  dose. 

*  Mr.  Tyrrell  relates  two  cases  of  temporary  amaurosis  produced  by  the  ex- 
tract, applied  to  the  surface  of  irritable  ulcers  of  a  malignant  character.  In  one 
case  the  disease  was  situated  in  the  vagina,  and  in  the  other  in  the  rectum.  The 
pupils  of  the  eyes  were  extremely  dilated,  as  from  the  application  of  the  extract 
to  the  organ  itself,  and  the  patients  were  incapable  of  distinguishing  any  objects 
for  some  hours.  In  the  case  of  ulcerated  vagina,  the  application  was  repeated, 
when  it  produced  exactly  similar  effects. — A.  Cooper's  Lectures,  vol.  i.  p.  79. 


NARCOTICS.  880 

I 

.Extract. — This  is  prepared  by  bruising  the  fresh  leaves  in  a  mortar, 
then  sprinkling  a  little  water  over  them,  expressing  the  juice,  then 
evaporating  to  a  proper  consistence.  Of  this  the  'lose  is  one  half  a 
grajn  repeated  two  or  three  limes  a  day.    To  ;i  child  one  twelfth  is 

snflieieiit.       Like  the  extract    of    hcmloek,   this    is    apt   to   vary    in    its 
strength. 

Diseases  in  which  the  IJklladonna  is  used. —  Variant  Affections 
of  the  Eye. — As  already  stated,  when  applied  to  the  eye,  it  dilute,  the 
pupil  and  produces  a  partial  paralysis. 

In  Cases  of  Cataract  this  is  resorted  to  with  great  advantage.  By 
the  great  dilatation  of  the  pupil  which  it  occasions,  it  enables  us  in  the 
first  place  to  ascertain  the  nature  and  extent  of  the  disease,  whether  the 
iris  be  adherent  to  the  capsule  of  the  crystalline  lens  or  not,  whether  the 
cataract  be  complete  or  only  partial.  Then,  in  the  operation,  it  gives 
great  advantage  in  fixing  the  iris  and  destroying  the  irritability  of  the 
organ. 

In  Inflammation  of  the  Iris,  where  adhesions  are  constantly  threat- 
ened, this  application,  by  dilating  the  pupil,  prevents,  and  sometimes 
breaks  up  partial  adhesions.'*  Finally,  in  irritability  of  the  eye  it 
answers  admirably  in  allaying  irritation  ;  it  is  also  used  in  opacity  of  the 
cornea.f  The  mode  of  applying  it  in  these  cases  is  to  drop  a  little  of  the 
infusion  into  the  eye,  or  a  little  of  the  extract  dissolved  in  water  may  be 
applied  to  the  lids.  J 

Upon  the  same  principle  it  has  been  applied,  locally,  with  success  to 
continued  rigidity  and  spasm  in  other  parts  of  the  system.  By  Chaus- 
sier  it  was  used  in  cases  of  rigidity  of  the  neck  of  the  womb,  interfering 
with  delivery.  For  this  purpose  he  employed  an  ointment  made  by 
rubbing  two  drachms  of  the  extract  with  an  ounce  of  lard.  Of  this,  a 
bit  the  size  of  a  filbert  was  applied  to  the  neck  of  the  womb,  and  gene- 
rally succeeded  in  relaxing  the  os  uteri.  §  By  Dr.  Conquest  the  same 
practice  was  resorted  to  with  great  success.  In  applying  the  belladonna 
in  cases  of  this  kind  it  is  to  be  used,  however,  with  caution,  as  the  para- 
lysis may  extend  to  the  uterus  itself.  A  case  of  this  kind  is  related  by 
Blackett,  in  which  both  the  neck  and  mouth  were  dilated  and  the  womb 
paralyzed.     Six  hours  intervened  before  the  contractions  of  this  organ 

*  See  Mackenzie,  specially,  p.  358. 

\  See  Bayle,  v.  ii.  p.  512.     Diet.  Mat.  Med. 

\  Mackenzie  directs  that,  the  evening  previous  to  the  operation,  extract  of  bella- 
donna, moistened  to  the  consistence  of  cream,  be  smeared  on  the  eyebrow  and  eye- 
lids, and  allowed  to  remain  till  about  half  an  hour  before  the  operation,  when  it  is  to 
be  washed  off  with  a  sponge  and  tepid  water.  If  the  pupil  is  not  by  this  time  fully 
dilated,  a  little  filtered  solution  of  extract  of  belladonna  in  water  is  to  be  dropped  on 
the  conjunctiva,  not  rudely  dashed,  with  a  hair  pencil — P.  502. 

§  See  Eberle,  v.  ii.  p.  78.     Diet.  Mat.  Med.  v.  i.  p.  492. 


390  MATERIA    MEDIC  A   AND   THERAPEUTICS. 

returned.*  [Used  in  this  way  it  has  produced  the  poisonous  effects  of 
the  drug.]  By  Chaussier  it  was  applied  also  in  uterine  convulsions. 
With  the  same  view  it  has  been  successfully  applied,  externally,  in  cases 
of  spasmodic  strictures  of  the  urethra  and  of  the  rectum,  in  chordee,\ 
haemorrhoids,  and  in  strangulated  hernia.  Four  cases  of  this  latter  kind 
are  stated  to  have  been  completely  relieved  in  this  way  .J 

Hooping  Cough. — In  this  disease  belladonna  has  been  extensively 
resorted  to.  On  the  continent  of  Europe  its  reputation  stands  exceed- 
ingly high.  Dr.  Eberle  states  that  he  used  it  in  twenty  cases,  and  in 
the  majority  with  great  advantage.§  He  recommends  it  to  be  given 
by  dissolving  four  grains  of  the  extract  in  an  ounce  of  sweetened  water, 
and  of  this  giving  from  eight  to  twelve  drops  three  times  daily  to  a 
child  under  two  years  old.  ||  By  Dr.  Thomson  one  eighth  of  a  grain 
was  given  to  a  child  eight  years  of  age,  and  gradually  increased  to  one 
fourth  of  a  grain.  By  Hufeland  the  proper  period  for  commencing  the 
use  of  this  remedy  is  said  to  be  about  the  fifteenth  or  twentieth  day  of 
the  disease. 

4.  Neuralgia. — In  this  rebellious  form  of  disease,  belladonna  has  been 
used,  and  in  many  cases  with  great  success.  Among  those  who  recom- 
mend it  most  highly  is  Dr.  John  Bailey  of  England.  The  cases  record- 
ed by  him  were  all  neuralgic  affections  of  the  head  and  face,  and  it  is 
when  seated  in  these  parts  that  he  considers  the  belladonna  peculiarly 
efficacious.  The  preparations  used  by  him  were  the  extract  and  the 
tincture.^" 

[Dysmenorrhcea. — Belladonna  has  been  used  with  success  in  this 
disease,  both  taken  internally,  applied  to  the  back  as  a  plaster  (empl. 
belladonna?),  and  introduced  into  the  vagina  as  a  suppository. 

Combined  with  ipecac  (half  a  grain  of  each),  it  has  in  my  hands 
exercised  more  control  over  this  affection  than  any  other  one  thing. 
-Ed.] 


DATURA    STRAMONIUM. 


'  This  is  commonly  known  by  the  names  of  the  Thorn  apple,  James- 
town weed,  Stinkweed,  &c.  It  is  an  annual  plant,  growing  to  the  height 
of  three  or  four  feet.  It  is  found  in  every  part  of  the  United  States, 
Canada,  Mexico,  South  America,  also  in  Europe,  Africa,  and  Asia. 
With  regard  to  the  native  country  of  this  plant  there  has  been  con- 

*  Bayle,  v.  ii.  p.  513.  f  Diet.  Mat.  Med.  v.  ii.  p.  492. 

%  Ibid.  Bayle,  513.  §  On  Children,  483,  also  Mat.  Med.  v.  i.  75. 

jl  Mat.  Med.  ii.  75.  1  Diet.  Mat.  Med.  vol.  i.  p.  492. 


NARCOTICS.  30] 

Biderable  difference  of  opinion.     The  common  belief  Beems  to  1":  io 

favor  of  its  being  a  native  of  this  continent,  and  that  it  travelled  through 
the  East  Indies  and  Persia  to  Europe.  In  the  earliest  English  vrritei 
on  plants  it  is  called  the  thorn  apple  of  Peru,  and  the  Spaniard  a  erl 
that  the  first  seeds  of  it  were  received  from  Peru,  under  the  name  of 
eachos,  and  that  it  had  previously  been  held  in  high  repute  as  a  medi« 
cinal  plant  both  by  the  natives  and  the  Spaniards  in  Peru.  Into 
England  it  was  introduced  in  the  reign  of  Queen  Elizabeth  from  '  !on- 
stantinople.  That  the  stramonium  is  not  a  native  of  the  United  States 
there  is  every  reason  to  believe.  It  is  always  discovered  along  the  roads 
and  near  habitations,  never  in  the  woods  and  mountains.  Mr.  Bafi- 
nesque  says  the  Indians  call  it  "the  white  people's  plant,"  and  he  adds 
that  its  migrations  can  be  traced  from  New  England  and  Virginia,  and 
that  in  the  Western  States  it  has  sprung  up  only  since  their  settlement, 
and  from  seeds  carried  there.  This  plant  blossoms  from  May  to 
September  in  the  Southern  States,  and  from  July  to  October  in  the 
Northern. 

Properties. — The  whole  of  this  plant  possesses  active  properties,  and 
has  a  foetid,  narcotic  smell,  which  of  itself  sometimes  causes  headache 
and  stupor.  The  parts  chiefly  used  in  medicine  are  the  leaves  and 
seeds. 

The  leaves  are  large,  from  five  to  six  inches  in  length,  of  a  deep 
green  color  on  the  upper  surface  and  pale  green  underneath.  When 
fresh  and  bruised  they  have  a  foetid,  narcotic  odor,  which  they  lose  on 
drying.  Their  taste  is  bitterish  and  nauseous,  and  when  chewed  they 
give  the  saliva  a  green  tinge. 

The  seeds  are  small  and  of  a  dark  coloi1,  having  the  peculiar  taste  of 
the  leaves,  but  destitute  of  smell. 

Chemical  Properties. — By  Brande  the  seeds  were  ascertained  to  con- 
tain a  peculiar  alkaline  principle,  which  he  called  datiirine,  gum,  a 
butyraceous  matter,  orange-colored  extractive,  together  with  various 
salts. 

The  active  properties  of  the  stramonium  are  yielded  both  to  alcohol 
and  water.  Daturine  exists  in  the  seeds  of  the  stramonium  in  combi- 
nation with  malic  acid.  In  its  pure  state  it  is  in  the  form  of  acicular 
prisms,  almost  insoluble  in  water  and  in  cold  alcohol.  In  boiling  alco- 
hol it  is  very  soluble,  and  with  the  acids  it  forms  crystallizable  salts. 

Effects. — In  its  action  on  the  system,  stramonium  resembles  bella- 
donna. In  moderate  closes,  it  causes  slight  vertigo,  and  sometimes  pain 
in  the  head,  dimness  of  vision,  and  dilatation  of  the  pupil.  In  some 
cases  nervous  sensations  are  excited  in  the  fauces,  amounting  even  to  a 
sense  of  suffocation,  but  more  commonly  only  heat  and  thirst.  Although 
not  soporific  like  opium,  it  produces  a  slight  tendency  to  sleep.  On 
the  circulation  the  effect  is  not  very  striking ;  in  some  cases  increasing 


392  MATERIA    MKDICA   AND    THERAPEUTICS. 

the  frequency  of  the  pulse  somewhat,  while  in  others  it  is  rendered 
slower.*  The  bowels  are  moderately  relaxed,  and  the  secretion  of 
urine  increased.  If  it  be  given  in  somewhat  larger  doses,  say  three  or 
four  grains  of  the  powdered  leaves,  in  a  few  minutes  it  produces  giddi- 
ness, nausea,  difficulty  of  speech,  with  great  thirst,  with  symptoms  ana- 
-logous  to  those  of  intoxication  from  alcohol. f  Like  belladonna,  it  uni- 
formly dilates  the  pupil.  This  is  the  case  especially  when  applied 
locally,  either  in  the  form  of  extract  or  watery  solution.  This  effect 
comes  on  in  about  half  an  hour  after  its  application,  and  continues  for 
about  two  da)'s.J 

In  jyoisonous  doses,  the  prominent  effects  are  sickness  at  stomach, 
loss  of  vision,  dilatation  of  the  pupil,  delirium,§  amounting  sometimes 
to  actual  mania  and  stupor ;  in  some  cases  spasms,  and  occasionally 
palsy  occur.  After  continuing  for  a  longer  or  shorter  period,  patients 
recover  from  these  effects,  although  sometimes  death  is  the  result. 

[I  have  seen  perfectly  well  marked  chorea  produced  in  a  child  of 
eight  years  by  swallowing  the  seeds  of  stramonium.  The  symptoms 
went  off  in  about  twelve  hours. — Ed.] 

Modes  of  Administration. — Powder. — Both  the  leaves  and  seeds  are 
used.  Of  the  powdered  leaves,  the  dose  is  from  two  to  three  grains; 
of  the  seeds,  which  are  stronger  than  the  leaves,  one  grain  may  be 
given  twice  a  day. 

Extract — Of  this  there  are  two  kinds,  the  one  made  from  the  leaves, 
the  other  from  the  seeds.  The  extract  from  the  leaves  is  prepared  by 
bruising  the  fresh  leaves  in  a  stone  mortar,  sprinkling  on  them  a  little 
water,  then  expressing  the  juice,  and  evaporating  to  a  proper  consis- 
tence. Prepared  in  this  way,  it  is  uncertain  as  regards  its  strength, 
differing  according  to  the  mode  of  conducting  the  process  of  evapora- 
tion, and  the  season  when  the  leaves  are  gathered.  The  average  dose 
is  about  a  grain,  night  and  morning,  gradually  increased  until  the  sys- 
tem is  affected. 

The  extract  from  the  seeds  is  prepared  by  macerating  a  pound  of  the 
seeds  in  a  gallon  of  boiling  water  for  four  hours ;  then  taking  out  the 
seeds  and  buising  them,  after  which  return  them  to  the  liquor ;  boil 
down  to  four  pints,  and  strain  while  hot.  After  this  evaporate  to  a 
proper  consistence.  The  extract  prepared  in  this  way  is  about  twice  as 
strong  as  that  from  the  leaves,  and  is  more  certain  in  its  effects.  The 
dose  is  from  Jto}a  grain  twice  a  day.  This  may  be  increased  every 
day  or  two  \  of  a  grain,  until  some  decided  effect  is  produced. 

Tincture. — This  is  prepared  by  macerating  four  ounces  of  the  bruised 
seeds  in  two  pints  of  diluted  alcohol  for  fourteen  days,  and  then  filter- 

*  See  Experiments  by  Cooper,  in  Caldwell,  p.  114.  for  1805.  f  Ibid.  p.  184. 

%  Cooper,  p.  173. 

§  For  a  striking  illustration,  quote  from  Cooper  in  Caldwell's  Therap.,  p.  186. 


NAECOTICS.  303 

ing.  Of  this  the  dose  is  from  ten  to  twenty  drops;  may  be  taken  two 
or  three  times  a  day,  arid  gradually  increased. 

Ointment. — One  pound  of  the  leaves  cut  into  pieces,  melted  with 
lard,  one  pound;  yellow  wax,  half  ;i  pound. 

Diseases  in  which  it  is  used. — From  the  analogy  in  effect  to  the  bel- 
ladonna, it  has  been  found  useful  in  very  much  the  same  kind  of  i 

e.'ises. 

Affections  of  the  Eye. — In  cataract,  inflammation  of  the  iris,  <fcc,  it 
is  used  with  similar  intentions  and  effects  as  the  belladonna  alr< 

noticed. 

Asthma. — In  this  disease  the  use  of  stramonium  in  the  form  of  smoke 
is  an  old  and  popular  remedy.  In  the  spasmodic  form  of  it  especially 
it  has  been  found  beneficial  during  the  paroxysm.  It  is  not,  however, 
infallible  in  its  operation.  In  some  cases  I  have  found  it  exceedingly 
advantageous,  while  in  others  it  has  produced  little  or  no  effect.  The 
mode  of  using  it  is  to  cut  the  dried  leaves  into  small  pieces,  and  then 
smoke  in  a  common  pipe,  precisely  like  tobacco.  Used  in  this  way,  it 
produces  all  its  narcotic  effects  on  the  system.  For  those  who  have 
been  accustomed  to  smoking  tobacco,  two  pipes  a  day  will  do  to  begin 
with,  but  for  others,  and  females,  a  single  pipe  will  be  sufficient.  As 
the  system  gets  accustomed  to  it,  the  quantity  may  be  increased  to 
several  pipes  a  day.  As  soon  as  nausea  or  vertigo  come  on,  the  smok- 
ing should  be  suspended. 

Stramonium  has  also  been  used  internally  in  asthma. 

Epilepsy. — This  was  one  of  the  diseases  in  which  the  stramonium 
was  earliest  used,  and  in  the  hands  of  some  with  considerable  success, 
while  in  those  of  others  it  has  not  accomplished  much.  By  Odhelius, 
a  Swedish  physician,  fourteen  cases  of  this  disease  were  treated  with  it 
in  the  Royal  Hospital  at  Stockholm.  Of  these,  eight  were  cured  and 
five  relieved,  and  only  one  did  not  receive  any  benefit.  During  its  use 
the  patients  suffered  transient  headache,  numbness,  and  obscurity  of 
vision. 

Neuralgia. — In  this  disease  the  success  of  stramonium  has  only  been 
partial.  By  Leutin,  a  physician  of  Hanover,  fourteen  cases  of  tic 
douloureux  were  treated  with  this  remedy  without  curing  a  single  case. 

By  Dr.  Read  of  Massachusetts  three  cases  were  recorded,  in  all  of 
which  the  stramonium  effected  a  radical  cure  of  the  complaint.  They 
were  all  of  considerable  duration,  and  various  other  remedies  had  been 
tried  without  any  essential  benefit.  It  was  given  in  the  form  of  extract, 
from  i  to  i-  a  erain. 


ANAESTHETICS 


BY    THE    EDITOR. 


This  term  is  applied  to  agents  which  diminish  or  temporarily  suspend 
the  general  sensibility  of  the  body.  The  idea  of  controlling  or  diminish- 
ing the  pain  of  surgical  operations  has  long  been  a  favorite  one,  and 
various  means  have  at  different  times  been  resorted  to  with  a  view  of 
realizing  it.  These  attempts  had  generally  failed  altogether,  or  met  with 
a  very  partial  success,  till  the  introduction  of  ether  inhalation.  Sir 
Humphrey  Davy  had  indeed  reported  his  success  in  controlling  pain  in 
his  own  person  by  the  inhalation  of  nitrous  oxide,  and  Mr.  Horace  Wells 
made  some  trials,  not  altogether  without  success,  with  the  same  agent 
so  early  as  1844.*  But  it  was  not  till  1846  that  Dr.  Morton  of  Boston, 
after  many  cautious  trials  on  himself  and  some  of  his  patients,  induced 
Dr.  J.  C.  Warren  to  use  sulphuric  ether  inhalation  in  an  operation   at 

[*  My  attention  was  directed  by  my  friend  Professor  Ellet  to  the  following  pas- 
sage in  the  works  of  Berzelius  which  contains  the  germ  of  the  idea  of  anaesthetics, 
of  the  general  character  of  ether,  chloroform,  etc.,  viz.  the  compounds  into  which 
hydrogen  enters  largely.  It  is  certainly  curious,  and  all  the  more  so  in  that  it 
affords  another  striking  proof  of  the  possibility  of  a  discovery  being  almost  made 
long  before  its  actual  and  practical  realization: — Ed.] 

Une  atmosphere  compost  de  gaz  oxygene  et  de  gaz  hydrogene  substitue  au  gaz 
nitrogene  rend,  au  bout  de  quelques  temps,  lourd  et  comme  engourdi,  mais  ne 
produit  pas  d'autres  signes  de  malaise.  Allen  et  Pepys  ont  vu  des  cochons  d'Inde 
qu'on  avait  laisses  au  milieu  d'une  pareille  atmosphere,  finir  par  tomber  dans  un 
sommeil  profond.  On  a  des  exemples  d'hommes  qui,  apr6s  avoir  respiree  pendant 
longtemps  un  melange  de  gaz  hydrogene  et  d'air  atmospherique,  se  trouvaient  pris 
chaque  fois  de  sommeil,  &a. — Berzelius,  torn.  i.  p.  85,  Bruxelles,  1838. 

Lorsque  Allen  et  Pepys  firent  respirer  des  cochons  d'Inde  dans  une  atmosphere 
de  quatre  parties  de  gaz  hydrogene  et  une  partie  de  gaz  oxygene,  ces  animaux  ne 
tarderent  pas  a  etre  plonges  dans  un  etat  d'assoupissement,  et  tomberent  dans  le 
sommeil,  sans  que  du  reste  aucun  symptome  de  maladie  se  manifestat  en  eux. 
Dans  un  experience  fait  a  Stockholm  par  Charles  de  Wetterstedt,  qui  laissa  respirer 
pendant  un  quart  heure  un  melange  d'une  partie  de  gaz  oxygene,  et  de  quatre 
parties  de  gaz  hydrogene  a  une  fille  de  vingt  ans,  atteinte  de  phthisie  pulmonaire, 
il  arriva  presque  chaque  fois  que  la  malade,  jusqu'alors  tourmentee  par  l'insomnie, 
fut  pris  d'envie  de  dormir,  et  tomba  dans  un  sommeil  paisible,  sans  que  du  reste 
aucun  changement  survint  dans  la  marche  de  la  maladie. — Berzelius,  torn.  iii. 
p.  556. 


ANVKBTHliTICB.  895 

the  Massachusetts  General  Hospital.  Tliis  operation  was  performed 
Oct.  15,  1846.  The  anaesthesia  was  but  partial.  The  next  day  another 
operation  was  performed  hy  Professor  Hay  ward,  in  which  ether  was 
used  with  the  effect  of  rendering  tlie  patient  completely  insensible  to 
pain.  From  this  beginning,  the  use  of  ether  spread  over  the  whole 
civilized  world  in  an  astonishingly  short  time,  and  from  every  quarter 
the  most  extravagant  reports  were  promulgated  of  its  wonderful  succi 
In  January,  1847,  ether  inhalation  was  first  used  to  control  the  pains  of 
parturition  hy  J.  Y.  Simpson,  M.D.,  of  Edinburgh.  It  was  used  in 
Paris,  Jan.  27,  by  Dr.  Deschampes;  and  Feb.  8,  in  his  Obstetrical 
Clinique,  by  Dubois.  In  London  it  was  tried  first  by  Professor  Murphy, 
Feb.  13,  1847,  and  in  this  country  by  Dr.  Kemp,  April  7,  1847.  Thus 
the  use  of  ether  in  midwifery  may  be  said  to  have  spread  over  Europe 
and  America  in  less  than  six  months.  In  November,  1847,  Dr.  Simp- 
son, after  making  very  many  experiments  with  various  agents  with  a 
view  of  discovering  some  substitute  for  ether,  was  induced  to  prefer 
chloroform,  and  soon  used  it  in  a  case  of  difficult  labor,  and  with  com- 
plete success.  Introduced  to  the  notice  of  the  profession  by  a  gentleman 
so  distinguished,  it  soon  gained  great  favor,  and  for  a  time  seemed  likely 
to  supplant  the  ether,  but  a  terrible  check  was  given  to  the  use  of  this 
article  in  particular,  and  to  that  of  anassthetics  in  general,  by  the  occur- 
rence of  several  cases  of  death  from  its  use.  These  cases  very  soon 
amounted  to  eighteen  or  twenty,  all  from  chloroform,  and  the  appre- 
hension that  many  more  were  concealed  by  the  criminal  want  of  candor 
of  those  in  whose  practice  they  occurred,  excited  in  the  minds  of  many 
professional  men  a  dread  of  the  new  practice,  and  as  rapidly  as  it  gained 
its  favor,  anaesthesia  lost  a  part  of  it,  but  not  all.  It  continued  to  be 
used  in  severe  surgical  operations,  in  obstetrical  operations,  and  by  some 
in  cases  of  natural  labor.  It  soon  became  the  subject  of  very  vehement 
disputation,  and  objections  of  all  sorts,  moral,  medical,  and  theological, 
were  urged  against  it.  But  at  length  the  practice,  in  some  sort, 
recovered  its  ground,  and  now  it  seems  to  have  established  itself  as  a 
valuable,  reliable,  and,  if  cautiously  used,  a  safe  means  of  relieving  our 
patients  from  the  pain  of  surgical  and  obstetrical  operations,  and  also  of 
controlling  several  very  severe  diseases.  This  appears  to  me  to  be  the 
present  state  of  professional  opinion  on  this  subject. 

Effects  of  Anaesthetics. — The  first  effect  is  stimulating  ;  the  ears  ring, 
the  patient  is  restless  and  sensible  of  confusion  of  intellect,  a  numbness 
is  felt  in  the  limbs,  sometimes  he  is  excited  to  violent  efforts  or  loud 
shouts ;  this  soon  passes  away,  and  a  sleep  more  or  less  profound  fol- 
lows ;  consciousness  is  lost,  the  muscles  are  rigid,  and  sensibility  is  only 
blunted.  Next  follow  muscular  relaxation  and  a  deeper  sleep,  conscious- 
ness and  sensibility  completely  gone,  breathing  sometimes  stertorous, 
though  regular;  pulse  regular.     The  next  stage  is  irregular  or  inter- 

26 


396  MATERIA   MEDICA   AND   THERAPEUTICS. 

rupted  respiration,  pulse  weak  and  fluttering,  and  no  doubt  if  this  con- 
dition is  allowed  to  continue  for  a  few  seconds,  respiration  would  be  al- 
together and  for  ever  interrupted,  and  death  ensue.  These  are  the 
ordinary  effects  of  the  inhalation  of  anaesthetics,  but  there  are  very  many 
irregularities  in  their  order  and  degree.  Sometimes  the  state  of  excite- 
ment is  not  at  all  noticeable,  and  the  system  passes  at  once  into  profound 
narcotism.  I  once  saw  a  lady  plunged  into  a  state  of  the  profoundest 
anaesthesia,  with  weak,  irregular  pulse,  snoring,  and  interrupted  respira- 
tion, by  making  three  or  four  inhalations  of  chloroform.  The  time  was 
not  ten  seconds.  This,  however,  is  rare,  and  the  probable  cause  of  it 
will  be  alluded  to  hereafter.  Very  frequently  the  stimulating  effects 
pass  by  so  rapidly  that  they  are  hardly  noticed,  and  certainly  would  not 
be  were  they  not  carefully  watched  for.  Then  again  they  are  violent 
and  long  continued,  so  as  to  impede  the  inhalation  very  much,  and  the 
patient  is,  if  an  operation  be  attempted  while  in  this  condition,  more 
unmanageable  than  if  no  anaesthetic  were  used.  Sometimes  conscious- 
ness survives  sensibility ;  this,  though  denied  by  Dr.  Snow  (Lancet,  Feb. 
12,  1848),  is  undoubtedly  true.  I  have  seen  it  very  many  times  in 
labor,  consciousness  perfect,  perceptions  clear,  yet  sensibility  to  pain 
markedly  diminished  or  completely  destroyed.  Irritation  of  the  stomach 
and  vomiting  are  not  very  unfrequent,  especially  if  food  has  been  recently 
taken.  Sometimes  sensibility  seems  to  remain,  though  consciousness  is 
lost ;  the  patient  screams  or  gives  other  evidence  of  suffering ;  but 
memory  has  no  place  for  these  sensations,  for  after  returning  conscious- 
ness the  patient  is  utterly  unaware  both  of  the  suffering  and  the  mani- 
festations of  it  he  may  have  given.  These  are  the  chief  effects  of 
anaesthetics. 

Modus  Operandi  of  Anaesthetics. — That  they  are  absorbed  is  beyond 
doubt ;  they  have  been  found  in  the  blood  in  very  many  cases.  Being 
then  conveyed  by  the  blood  to  the  great  nervous  centres,  these  in  suc- 
cession lose  their  power.  The  order  in  which  they  are  affected  is  thus 
given  by  Flourens.  First,  the  cerebral  lobes  lose  their  power  and  intel- 
lect is  impaired ;  then  the  cerebellum  is  affected  and  the  power  of  regu- 
lating locomotion  is  lost ;  afterwards  the  spinal  marrow,  and  sensation 
and  motion  are  gone  ;  lastly,  the  medulla  oblongata,  the  motive  power 
of  respiration,  breathing,  ceases,  and  death  is  the  result.  This  sounds 
very  well,  but  it  seems  to  me  that  any  one  who  has  studied  this  matter 
by  the  bedside  will  be  quite  unable  to  reconcile  what  he  there  sees  with 
the  ordo  of  Mr.  Flourens.  What,  for  example,  was  the  state  of  the 
cerebrum  and  cerebellum  in  the  Irishman  operated  on  at  London 
Hospital,  who  made  faces  and  jokes  while  insensible  of  the  pain  of  an 
amputation  !*     Is  the  cerebrum  and  cerebellum  affected  when  a  patient 

Lond.  Med.  Gaz.,  Jan.  22,  1847. 


ANAESTHETICS.  .:')7 

in  labor  takes  the  handkerchief  from  her  attendant,  presses  it,  to  bet 
face,  and  expresses  in  the  warmest  terms  the  relief  from  pain  which  it 
affords  her?     All  this  must  manifestly  l>c  restudied. 

Circumstances  modifying  the  affect  of  Anaesthetics. — On  this  subject 
we  want  facts.  Age  does  not  seem  to  contra-indieatc  their  use,  as  Pro- 
fessor Gross  says  ho  has  administered  chloroform  to  patients  of  every 
age  from  sixteen  months  to  seventy  years  without  any  evil  effects.  Sex, 
too,  seems  to  have  little  influence,  and  if  any  such  power  belong  to 
climate  we  are  yet  unable  to  appreciate  it. 

State  of  the  System. — The  only  thing  from  which  we  should,  d priori, 
expect  a  modification  of  the  effect  of  anaesthetics,  is  present  pain,  but  I 
am  not  sure  that  there  is  any  difference  in  the  facility  with  which  the 
anaesthetic  state  is  produced  in  the  patient  about  to  submit  to  a  surgical 
operation  and  the  woman  actually  suffering  pain  of  labor  at  the  time 
the  anaesthetic  is  given.  The  one  seems  to  me  to  pass  into  the  anaes- 
thetic state  as  readily  as  the  other. 

States  of  the  System  unfavorable  and  favorable  to  the  use  of  Anaesthe- 
tics.— The  conditions  under  which  anaesthetics  are  most  likely  to  act 
irregularly  are. — 1.  Very  great  plethora;  from  the  observations  of  Du- 
bois and  others,  it  would  seem  most  prudent  to  remove  this  plethora 
before  the  agent  is  administered.  Yet  having  done  this,  care  must  be 
taken  as  to  the  manner  in  which  the  anaesthetic  is  given,  as  it  usually 
acts  much  more  promptly  immediately  after  a  bleeding,  or  when  the 
system  is  much  reduced,  than  under  other  circumstances.  In  the  case 
to  which  I  have  already  alluded,  where  its  effects  were  so  rapid  and  so 
serious,  the  chloroform  was  given  immediately  after  a  free  bleeding.  2. 
The  presence  of  serious  disease  of  the  heart  or  great  vessels  has  been  by 
Mr.  Wakley  and  others  said  to  contra-indicate  the  use  of  anaesthetics. 
This  has  been  denied — certainly  the  existence  of  such  organic  affection 
should  make  us  pause  and  duly  reflect  on  the  question,  and  if  we  judge 
it  best  to  use  the  anaesthetic,  no  doubt  great  care  should  be  taken  to 
shorten  or  avoid  altogether  the  period  of  excitement. 

Mode  of  Administration. — A  very  great  variety  of  inhalers  have  been 
proposed.  They  have  nearly  all  gone  out  of  use,  and  ether  is  now  almost 
constantly  poured  upon  a  cupped  sponge  and  held  over  the  nose  and 
mouth,  while  chloroform  is  dropped  upon  a  handkerchief  and  held  in 
the  same  way. 

Rules  for  the  Administration  of  Anaesthetics. — 1.  The  patient  should 
not  take  food  immediately  before  the  operation.  2.  The  mind  should 
be  as  far  as  possible  calm  and  composed.  3.  Quiet  around  is  of  the 
utmost  importance — loud  talking,  addressing  questions  to  the  patient, 
&c.,  are  all  likely  to  interfere  with  the  production  of  the  anaesthetic 
state.  4.  As  to  how  rapidly  the  patient  should  be  hurried  through  the 
state  of  excitement  there  is  difference  of  opinion,  and  a  different  rule 


398  MATERIA   HEDICA   ANC  THERAPEUTICS. 

should  prevail  as  the  agent  is  ether  or  chloroform.  If  ether  is  used,  the 
stimulation  is  often  troublesome,  and  the  deeper  stages  of  narcotism  not 
readily  produced.  We  ought,  therefore,  to  hurry  forward  the  process, 
place  the  cupped  sponge  over  the  nose  and  mouth,  not  pressing  on  the 
skin,  but  quite  near,  and  urge  the  patient  to  take  full  free  inspirations — 
let  them  follow  each  other  as  rapidly  as  is  consistent  with  their  being 
full  and  deep.  As  to  chloroform,  Prof.  Simpson  advises  that  the  patient 
should  be  plunged  as  rapidly  as  possible  into  complete  anaesthesia.  This 
is  not  the  course  I  would  recommend.  I  think  the  practitioner  will  do 
better  to  feel  his  way  a  little,  and  allow  the  effects  of  the  agent  to  de- 
velop themselves  gradually.  There  will  every  now  and  then  be  trouble 
with  the  stimulating  effects,  but  there  will  be  less  danger.  5.  Care 
should  be  taken  that  the  supply  of  atmospheric  air  is  at  all  times  ade- 
quate. There  is  little  doubt  but  that  several  of  the  fatal  cases  depended 
on  an  inadequate  supply  of  air.  6.  Watch  the  case  from  the  first  inha- 
lation till  consciousness  and  sensibility  have  completely  returned.  One 
person  should  in  all  operations  have  charge  of  the  anaesthetic,  and  he 
should  think  of  nothing  else.  In  one  fatal  case  the  attendant  who  should 
have  watched  the  patient  was  looking  at  the  operation,  and  the  man 
died.  The  person  who  has  this  charge  should  keep  his  finger  on  the 
pulse  and  watch  the  respiration  every  single  moment  of  the  time — not 
one  inspiration,  not  one  beat  should  the  heart  give  that  he  does  not 
take  note  of.  The  moment  the  respiration  is  irregular  or  the  pulse 
begins  to  flag  or  flutter,  the  inhalation  should  cease,  and  a  puff  or  two 
of  fresh  air  be  blown  into  the  face.  As  to  the  degree  to  which  the 
effects  should  be  carried,  it  will  differ  in  different  cases.  In  natural 
labor  we  need  ordinarily  go  no  further  than  to  obtund  pain,  and  this 
can  generally,  I  think,  be  done  without  disturbing  consciousness.  In 
surgical  operations,  complete  relaxation  of  the  muscles  and  profound 
sleep  is  generally  required.  This  state,  however,  must  be  watched,  and 
when  the  breathing  becomes  stertorous  the  inhalation  should  be  sus- 
pended. If  the  breathing  is  irregular  or  interrupted  the  danger  is  most 
imminent,  and  every  means  of  keeping  up  respiration  should  be  resorted 
to.  Artificial  respiration  is  the  sheet  anchor  in  such  eases,  and  I  have 
known  great  danger  removed  by  prompt  and  continued  artificial  respi- 
ration. Everything  will  depend  on  the  coolness  and  self-possession  of 
the  operator.  7.  When  the  patient  is  allowed  to  emerge  into  conscious- 
ness everything  that  can  startle  or  shock  should  be  avoided,  and  the 
brain  allowed  quietly  to  recover  its  equipoise.  Ammonia,  oxygen,  gal- 
vanism, &c.  &c,  have  been  proposed  as  remedies  in  excessive  anaesthe- 
sia. They  amount  to  nothing.  Artificial  respiration  is  the  alpha  and 
omega. 

Applications  to  Disease. — In  Surgical    Operations    anaesthetics    are 
almost  universally  used.     On  this  subject,  having  no  experience  of  my 


ANiESTIIKTJCS.  8W 

own,  as  I  do  not  practise  Burgery,  I  will  quote  the  emphatic  language  of 
my  distinguished  friend,  Prof.  Gross.    "  I   have  never  noticed  in  any  <>f 

my  cases  that  the  rise  of  chloroform  exerted  any  injurious  effects  on   the 
recovery  of  my  patients."* 

In  Midwifery. — Here  the  fate  of  anaesthetics  has  been  very  different 
from  that  which  it  met  in  surgery.  From  its  first  introduction  into  ob- 
stetrical practice  to  the  present  time,  objections  of  all  sorts  have  been 
urged  against  it,  and  evil  consequences  of  all  kinds  attributed  to  it.  It 
was  immoral,  for  it  excited  in  the  patient  indelicate  ideas,  and  might 
prompt  to  improper  words.  It  was  irreligious — God  had  said  to  woman 
"in  sorrow  shalt  thou  bring  forth  children" — anaesthesia  tried  to  escape 
this  curse.  It  predisposed  to  hemorrhage,  to  puerperal  convulsions,  to 
mania,  &c.  The  child  might  be  poisoned,  made  an  idiot,  &c.  &c.  To 
this  a  great  deal  of  jargon  has  been  added  about  pain  being  a  "  conser- 
vative manifestation  of  life  force"  "  being  'physiological"  and  the  like. 
These  objections  of  course  never  had  any  weight,  and  having  served 
their  purpose  of  attracting  attention  to  their  authors,  may  now  be  chari- 
tably forgotten.  But  more  tangible  objections  have  been  made  to  anaes- 
thesia in  midwifery.  It  is  said  to  interfere  with  uterine  contraction,  and 
thus  augment  the  duration  of  labor.  That  the  first  administration  of 
anaesthetics  ordinarily  checks  pain  is  certain,  but  in  almost  every  case  it 
promptly  returns,  and  is  quite  frequently  more  efficient,  so  that  it  is  at 
least  doubtful  -whether  the  duration  of  the  process  is  greater ;  but  even 
though  it  were,  are  not  the  advantages  obtained  worth  the  sacrifice?! 
As  to  its  evil  influence  post  partwm,  I  do  not  believe  that  there  is  exist- 
ing any  proof  of  such  influence.  The  recoveries  after  its  use  are  cer- 
tainly as  rapid  and  as  satisfactory  in  every  respect  as  those  without  it, 
and  most  practitioners  who  speak  from  any  large  experience  think  more 
so.  But  the  great  objection  to  anaesthetics  remains.  They  have,  and 
that  in  a  very  considerable  number  of  cases,  caused  death.  They  are 
then  dangerous  to  life — that  is  the  great,  the  sole  objection  to  them. 
This  being  certain,  as  I  think  it  is,  the  question  returns  in  this  form : 
Are  the  advantages  gained  by  the  use  of  anaesthetics  in  midwifery  suffi- 
ciently important  to  justify  us  in  the  use  of  an  agent  which  may  destroy 
life  ?     What  are  these  advantages? 

1st.  Immunity  from  pain.  While  the  old  adage  that  "pain  is  an  evil" 
holds  true,  this  will  be  by  all  rational  persons  admitted  to  be  a  very 
great  advantage. 

2d.  Immunity  from  the  shock  which  great  physical  pain  often  inflicts 
on  the  nervous  system.  This  shock  is,  we  know,  sometimes  so  great  as 
directly  to  destroy  life ;  it  very  frequently  produces  a  depressing  influ- 

*  Trans.  Am.  Med.  Ass.,  vol.  iii.  p.  392. 

f  Subsequent  experience  has  convinced  me  that  the  pains  of  labor  are  more  fre- 
quently made  extra-efficient  than  interrupted. 


400  MATERIA   MEDICA  AND   THERAPEUTICS. 

ence,  from  which  the  patient  does  not  rally  for  hours  or  days.  This  is 
seen  after  labor  in  nervous,  delicate  women,  who,  having  large  children, 
suffer  very  severely  in  parturition.  In  this  state  of  things  we  are  very 
frequently  obliged  to  give  narcotics,  and  even  in  some  cases  these  fail  for 
a  long  time  to  control  the  excited  nervous  system.  Now  anaesthetics  pre- 
vent all  this  :  opiates  remove  or  control  it.  But  is  it  not  safer  to  prevent 
than  control  evil  ?  If  this  be  true,  if  pain  is  not  only  an  evil  in  itself,  but 
if  it  and  it  alone  can  and  does  in  any  considerable  number  of  cases  endan- 
ger or  destroy  human  life,  we  are  surely  justifiable  in  using  a  means  of 
warding  off  that  danger,  provided  the  one  to  which  we  expose  our 
patient  is  not  greater  than  that  from  which  we  protect  her?  What  pro- 
portions do  these  two  dangers  bear  to  each  other  ?  We  have  no  statis- 
tics that  enable  us  to  answer  this  question  confidently,  and  must,  there- 
fore, only  answer  it  conjecturally.  What  is  the  danger  attending  the 
use  of  anaesthetics  ?  The  number  of  fatal  cases  authentically  reported 
is,  I  believe,  about  twenty.*  To  how  many  thousands  and  tens  of  thou- 
sands have  anaesthetics  been  given  ?  How  very  small,  ay,  and  consi- 
dering the  careless  way  in  which  it  was  first  used,  how  wonderfully  smaP 
is  this  proportion  of  fatal  cases  ?  On  the  other  hand,  what  is  the  danger 
to  life  from  the  pain  (mere  pain)  of  childbirth  ?  In  natural  labor  and 
in  healthy  women  infinitely  small.  In  nervous,  timid,  excitable  women 
(natural  labor)  not  so  very  small.  In  cases  of  lingering  labor,  especially 
where  the  labor  depends  on  a  rigid  perinenm,  the  danger  is  by  no  means 
small ;  and  when  we  come  to  the  severely  painful  operations,  as  turnings 
the  forceps,  removing  retained  placenta  (hour-glass  contraction)  it  is  very 
considerable — much,  much  greater  than  the  danger  from  anaesthetics' 
From  these  premises  I  deduce  the  rules  as  to  the  use  of  anaesthetics  in 
midwifery.  In  natural  labor,  in  patients  of  good  constitution,  free  from 
nervousness,  it  need  not  be  given.  In  the  nervous,  timid,  excitable  wo- 
man, it  may  be  given,  even  in  natural  labor.  In  lingering  labor,  where 
the  pains  are  severe  and  the  suffering  great,  it  ought  to  be  given.  In 
severe  operations  it  manifestly  and  indubitably  increases  the  patient's 
chance  of  recovery,  and  may  not  justifiably  be  withheld. 

In  Delirium  Tremens. — Anaesthetics  have  been  used  in  this  disease 
in  very  many  cases,  and  generally  with  the  most  pleasant  effects.  It  is 
often  somewhat  difficult  to  get  the  patient  fairly  under  the  influence  of 
the  agent  (especially  if  ether  be  used),  but  once  overcome,  he  is  gene- 
rally quiet,  and  the  artificial  usually  passes  into  natural  sleep,  which  con- 
tinues for  many  hours ;  the  patient  generally  wakes  up  calm  and 
composed.  In  these  cases,  care  should  be  taken  not  to  overwhelm  the 
weak,  exhausted  system,  but  to  introduce  the  anaesthetic  somewhat 
gradually. 

*  Now  (1856)  alas  I  much  larger. 


ANAESTHETICS.  401 

In  Puerperal  Convulsions. — After  suitable  sanguineous  depletion, 
anaesthetics  may  be  tried  with  the  best  effects.  The  violence  of  the 
spasms  is  promptly  controlled,  and  the  lit.  very  often  arrested  al  once. 
Here  the  caution  as  to  the  administration  of  anaesthetics  immediately 
after  bleeding,  heretofore  given,  would  apply. 

In  Spasmodic  Asthma. — Anaesthetics  have  in  some  cases  been  given 
with  entire  and  immediate  relief  to  the  paroxysm;  of  course  they  would 
produce  no  curative  effect  on  the  disease;  but  if  they  only  give  tempo- 
rary relief  to  a  fit,  it  is  no  small  boon. 

Idiopathic  Tetanus. — Mr.  Carey  reports  in  the  London  Lancet  (Feb. 
1848)  a  case  in  which  chloroform  was  used  with  success.  It  was  admi- 
nistered so  as  to  keep  the  patient  under  its  influence  for  some  time.  Dr. 
I.  Parrish,  of  Philadelphia,  has  reported  another  connected  with  erysi- 
pelas. It  has  also  been  used  repeatedly  in  traumatic  tetanus  and  hydro- 
phobia, with  the  effect  of  mitigating  the  sufferings,  though  not  prolonging 
the  life  of  the  patient. 

In  Neuralgia. — This  is  one  of  the  diseases  in  which  anaesthetics 
have  been  used  most  frequently,  and  with  the  greatest  success.  They 
very  rarely  fail  to  remove  for  a  time  the  pain,  and  though  on  the  patient 
returning  to  a  conscious  state  the  pain  often  returns,  yet  a  repetition  of 
the  remedy  usually  removes  it  again  ;  and  after  two  or  three  such  returns 
the  disease  has  in  many  cases  been  entirely  removed. 

individual  anaesthetics. 

Sulphuric  Ether. — This  was  the  agent  first  used,  and  it  continues 
to  be  the  favorite  with  a  small  portion  of  the  faculty.  Its  advantages 
are :  1st.  It  is  more  stimulating,  and  may  therefore  be  given  to  patients 
very  much  exhausted,  with  a  view  to  its  stimulating  as  well  as  to  its 
anaesthetic  effects.  Its  main  advantage,  however,  over  chloroform  is 
safety.  Not  more  than  one  or  two  deaths  have  been  satisfactorily 
traced  to  the  use  of  ether. 

Objections. — It  is  so  stimulating  that  it  is  difficult  to  get  some 
patients  beyond  the  state  of  excitement.  It  has  to  most  persons  an 
exceedingly  disagreeable  odor,  and  this  is  very  permanent.  It  excites 
coughing  very  often  and  headache  not  unfrequently.  To  some  persons 
it  is  so  disagreeable  that  they  cannot  take  it*  Still  as  it  is,  from  the 
slowness  of  its  operation,  safer  than  chloroform,  I  would  advise  all 
persons  to  make  their  essays  in  the  use  of  anaesthetics  with  ether;  when 
repeated  observations  have  given  them  confidence  based  on  knowledge 
they  may  try  the  more  dangerous  agent. 


402  MATERIA   MEDICA   AND  THERAPEUTICS. 

Mode  of  Administration. — Ether  should  be  poured  on  a  large  cupped 
sponge,  and  this  held  immediately  over  the  mouth  and  nose,  but  not 
pressed  down  upon  the  face.  As  soon  as  the  respiration  becomes  deep 
and  moderately  slow,  the  sponge  should  be  raised,  that  a  larger  propor- 
tion of  air  may  enter  the  lungs ;  the  impression  can  then  be  rendered 
deeper,  if  desired.  The  quantity  of  ether  required  to  produce  full 
anaesthesia  is  about  an  ounce,  but  much  more  is  often  used,  part  being 
•wasted. 

Chloroform. — This  is,  in  chemical  language,  a  Tcrchloride  of  For- 
myle.  It  was  discovered  by  Soubeiran,  1831,  and  Liebig,  1832.  It 
consists  of  two  atoms  of  carbon,  three  of  chlorine,  and  one  of 
hydrogen. 

Physical  Properties. — A  clear  limpid  fluid,  very  volatile,  boils  at 
140°.  Sp.  gr.  1.480,  a  pleasant  fruit  smell,  and  a  sweet  taste.  It  is  not 
inflammable — has  great  power  as  a  solvent. 

Preparation. — It  is  usually  made  by  the  distillation  of  dilute  alcohol 
and  chloride  of  lime. 

Adulteration. — It  is  often  adulterated  with  alcohol,  which  may  be 
discovered  by  testing  the  sp.  gr.  It  should  not  be  used  if  below  1.400. 
Sometimes  it  contains  sulphuric  acid.  This  may  be  detected  by  litmus 
paper,  or  the  action  of  nitrate  of  baryta,  on  distilled  water  shaken  with 
the  chloroform. 

Effects. — Chloroform  is  more  powerful  as  an  anaesthetic  than  ether 
in  the  proportion  of  about  eight  to  one.  It  is  far  less  stimulating,  and 
the  stage  of  excitement  it  produces  is  so  short,  if  a  full  dose  is  adminis- 
tered, as  scarcely  to  be  perceptible ;  the  patient  passes  almost  instantly 
into  sleep,  more  or  less  profound.  It  sometimes  excites  nausea  and 
vomiting,  but  very  rarely  coughing,  choking,  or  any  of  those  evidences 
of  irritation  of  the  air  passages  from  which  so  much  trouble  is  experi- 
enced when  ether  is  administered.  In  fact,  it  is  perfectly  agreeable — 
very  powerful — very  certain  in  its  effects,  but  also  very  dangerous,  espe- 
cially if  not  watched  most  assiduously. 

Mode  of  Administration. — Chloroform  is  usually  given  in  a  handker- 
chief, twenty  or  thirty  drops  (not  more  than  thirty)  are  poured  on  it, 
and  the  handkerchief  placed  about  an  inch  from  the  face;  the  patient 
should  be  encouraged  to  take  deep,  full  inspirations ;  a  little  agitation 
will  soon  be  manifested,  but  this  will  generally  pass  away  in  a  moment, 
and  the  patient  will  continue  tranquilly  and  with  apparent  pleasure  to 
inhale.  Often,  if  efforts  be  made  to  remove  it,  they  will  be  resisted; 
gradually  the  brain  is  oppressed,  consciousness  lost ;  next  come  muscu- 
lar relaxation  and  deep,  perhaps  stertorous  breathing.  Stop,  now,  and 
et  the  operator  do  his  work ;  if  the  patient  rouse,  give  the  chloroform 
again  ;  a  few  deep  inspirations  will  probably  complete  the  insensibility. 


ANAESTHETICS.  408 

When  it  is  desirable  that  the  patient  should  revive,  let  this  be  without 
noise  or  confusion,  and  let  consciousness  return  perfectly  before  any  ques- 
tions :ire  asked  or  remarks  made.  Let  me  in  conclusion  l><;g  every  one 
who  reads  these  directions  never  to  use  chloroform  without  watching 
every  respiratory  act  and  having  the  finger  upon  the  pulse  every  moment. 
In  no  other  way,  I  am  quite  sure,  can  danger  be  avoided.  And  I  would 
beg  those  who  read  this  caution  to  remember  that  it,  and  the  representa- 
tions of  the  danger  of  any  but  the  most  cautious  use  of  this  drug,  come 
from  one  of  the  earliest  and  most  earnest  of  the  advocates  for  its  obstetric 
use — one  who  uses  it  constantly  and  habitually  in  all  his  cases  of  obstetric 
operations — in  most  of  those  of  lingering  and  painful  labor,  and  in  not  a 
few  of  natural  labor.  Yet  has  my  experience  so  taught  me  that  I  never 
touch  this  agent  without  dread,  and  am  deeply  conscious  that  nothing 
but  unremitting  vigilance  has  saved  me  from  producing  with  it  the  most 
disastrous  effects. 

Chloric  Ether. — This  is  a  mere  dilution  of  chloroform  with  alcohol, 
in  the  proportion  of  one  of  the  former  to  eight  of  the  latter.  It  is  used 
exclusively  by  Dr.  Warren  at  the  Mass.  Gen.  Hospital  ;  he  thinks  that 
it  is  more  pleasant  than  sulphuric  ether,  and  safer  than  chloroform.  It 
has  not  the  unpleasant  smell  of  sulphuric  ether,  does  not  produce  pul- 
monary irritation,  and  very  rarely  headache.  It  is  more  apt  to  produce 
nausea,  which  Dr.  W.  thinks  rather  an  advantage  than  an  objection. 
The  opinions  of  this  distinguished  surgeon  are  worthy  of  all  possible 
respect.  Chloric  ether  is  also  employed  by  Dr.  Knight  of  New  Haven, 
and  other  surgeons  at  home  and  abroad. 

Dose  and  Mode  of  Administration. — The  same  as  sulphuric  ether. 

Chloroform  and  Ether. — A  mixture  of  the  two  anaesthetics  in  pro- 
portions of  either  one  of  chloroform  to  two  of  ether,  or  one  to  three,  is 
employed  by  Prof.  Brainard  of  Chicago,  Dr.  W.  Atlee  of  Pennsylvania, 
and  some  other  surgeons.  It  is  supposed  to  combine  the  excellences  of 
both  agents. 

Cold. — The  use  of  intense  cold  as  an  anaesthetic  was  introduced  to 
professional  notice  by  Dr.  James  Arnott,  in  1848.  It  has  since  been 
used  quite  frequently  by  him  and  by  other  English  surgeons,  and  very 
often  with  success.  On  the  continent  it  has  been  little  used,  and  I  do 
not  find  that  the  operating  surgeons  of  New  York  are  very  partial  to  it. 
Arnott  has  proved  beyond  doubt  that  it  is  a  great  mistake  to  suppose 
that  because  long-continued  congelation  destroys  the  vitality  of  a  part 
the  same  or  any  other  evil  effect  would  follow  a  short-continued  conge- 
lation. The  fact  being  that  a  part  may  be  benumbed,  the  circulation 
through  it  stopped,  the  skin  and  adipose  matter  congealed,  aud  this  con- 


404  MATERIA  MEDICA   AND  THERAPEUTICS. 

tinued  for  five  or  six  minutes,  and  yet  the  vitality  of  the  part  be  entirely 
restored.  Cold  thus  used  entirely  destroys  the  sensibility  of  the  skin, 
but  its  influence  does  not  seem  to  have  extended  in  any  great  degree  to 
the  parts  beneath. 

Mode  of  Use. — Pound  a  bit  of  ice  (the  size  of  a  large  orange  will  be 
enough  if  the  congelation  is  not  to  be  extensive),  mix  with  it  about  half 
its  weight  of  salt,  and  put  it  into  a  gauze  net,  and  apply.  It  should 
not  be  kept  motionless  on  the  part,  but  frequently  raised  that  the  water 
may  escape  or  be  sponged  up. 

The  skin  is  benumbed  almost  immediately,  there  is  hardly  a  sensation 
of  cold,  and  no  tingling  or  smarting  whatever.  The  surface  soon  be- 
comes white  and  hard.  It  seems  to  me  that  our  surgeons  ought  to  give 
this  plan  of  Arnott's  a  full  trial.  My  friend,  Prof.  White  of  Buffalo, 
tells  me  that  he  has  used  carbonic  acid  as  an  anaesthetic  in  cancer  uteri, 
with  good  effect.  A  bent  tube  connected  with  the  gas  generator  was 
introduced  into  the  vagina. 

[As  Dr.  Beck  did  not  lecture  on  anaesthetics,  I  have  been  obliged  to 
supply  this  sketch. — Ed.] 


STIMULANTS. 


Stimulants  are  those  medicinal  agents  which  increase  the  vita 
movements  of  the  system  at  large.  Their  general  effects  are  simple 
and  obvious ;  almost  as  soon  as  taken  into  the  stomach,  they  produce 
a  sensation  of  warmth,  which  soon  diffuses  itself  over  the  whole  body. 
The  action  of  the  heart  and  arteries  is  accelerated ;  the  pulse  more  fre- 
quent and  stronger ;  the  muscular  system  is  invigorated,  while  general 
energy  is  imparted  to  the  brain  and  nervous  system.  In  all  cases  the 
effects  are  more  or  less  temporary,  varying  with  the  stimulant  and  the 
quantity  used.  Some  are  peculiarly  evanescent  in  their  action,  others 
more  permanent.  All  are  followed  by  languor  and  debility.  Let  us 
analyse  a  little  in  detail  the  effects  of  these  remedies  on  the  different 
parts  of  the  system. 

1.  On  the  Brain  and  Nervous  System. — The  brain  experiences  a 
marked  increase  of  power  and  activity.  The  senses  all  become  more 
acute.  The  intellectual  faculties,  the  imagination  more  especially,  are 
stimulated,  the  passions  excited,  and  every  good  and  evil  propensity 
roused  into  exercise. 

2.  On  the  Urinary  System. — The  effects  of  these  agents  are  strik- 
ing and  peculiar.  In  the  first  place,  they  usually  increase  the  quantity 
of  urine  secreted.  This  may  be  accomplished  by  the  general  impulse 
given  to  the  circulation,  involving  the  kidneys  in  the  universal  excite- 
ment. In  the  second  place,  besides  increasing  the  quantity  they  alter 
its  quality.  It  becomes  high  colored  and  irritating.  Hence  the  heat 
and  uneasiness  which  it  occasions  in  all  the  surfaces  over  which  it 
passes. 

3.  On  the  Skin. — In  the  general  excitement  of  the  circulation  which 
follows  the  use  of  stimulants,  there  is  no  part  which  participates  more 
decidedly  than  the  skin.  The  capillaries  are  filled,  heat  is  developed, 
and  the  secretion  from  the  surface  augmented. 


406  MATERIA   MEDICA   AND  THERAPEUTICS. 


CIRCUMSTANCES    MODIFYING     THESE     EFFECTS. 

Age. — This  modifies  the  effects  of  stimulants  in  a  very  striking  man- 
ner. Their  power  is  always  manifested  in  proportion  to  the  degree  of 
sensibility  and  mobility  in  the  system.  In  early  life  their  action  is, 
therefore,  much  more  decided  than  afterwards.  When  judiciously  used, 
their  effects  are  most  remarkable  in  invigorating  the  system.  When 
improperly  given  their  evil  effects  are  quite  as  decided.  The  reason  of 
this  is  plain  ;  in  early  life  the  circulation  is  naturally  rapid  and  irregu- 
lar, hence  local  congestions  are  common.  Now,  stimulants  still  further 
hurry  the  circulation  and  increase  the  danger.  At  this  period,  there- 
fore, stimulants  should  be  generally  avoided.  In  old  age,  on  the  con- 
trary, the  circulation  is  sluggish,  the  sensibility  exhausted  ;  here  stimu- 
lants may  be  used  with  freedom,  and  their  effect  is  less,  but  their  use  is 
unattended  with  the  dangers  which  it  has  in  infancy  and  ehildhood. 

Sex. — From  the  greater  delicacy  and  excitability  of  the  female  sys- 
tem, stimulants  produce  a  more  decided  effect  on  women  than  they  do 
on  men.  Besides  the  general  difference  of  constitution  there  are  other 
circumstances  which  modify  the  effects  of  stimulants  in  the  female. 
This  is  especially  the  case  during  pregnancy.  In  this  condition  of  the 
female  system,  there  is  always  increased  excitement  present.  Hence  it 
is  very  evident  that  the  general  effect  of  stimulants  must  be  very  differ- 
ent from  what  it  is  in  the  ordinary  state  of  the  system. 

Temperament  and  Constitution. — In  sensitive  and  sanguine  tempera- 
ments, stimulants  produce  more  excitement  than  in  the  melancholic  and 
phlegmatic.  In  the  application  of  this  class  of  agents  to  the  treatment 
of  diseases  this  fact  is  always  to  be  borne  in  mind. 

Climate. — Of  all  the  circumstances  modifying  the  effects  of  stimu- 
lants this  is,  perhaps,  the  most  striking.  The  inhabitants  of  Northern 
regions,  whose  sensibility  is  blunted  by  the  rigor  of  the  climate,  can 
bear  much  larger  quantities  of  ardent  liquors  than  those  of  warmer 
latitudes.  The  apathetic  Russian  can  take  with  impunity  what  would 
prove  destructive  to  the  sensitive  inhabitant  of  the  South  of  Europe. 
Even  in  our  climate  temporary  exposure  to  the  benumbing  influence  of 
cold  will  produce  a  similar  effect.  A  person  thus  exposed  may  safely 
take,  without  any,  or  at  least  a  trifling  effect,  what  would  be  sufficient, 
under  other  circumstances,  to  intoxicate  him. 

Repetition. — The  same  general  law  holds  good  here  that  is  found  to 
prevail  in  other  classes  of  agents.  The  system  becomes  gradually  habi- 
tuated to  the  impression  which  they  make,  and  to  produce  the  same 
effect  larger  quantities  are  required.  Illustrations  of  this  fact  are  fami- 
liar to  everybody.  It  is  exemplified  in  the  history  of  every  person 
addicted  to  the  use  of  intoxicating  liquors.     I  once  knew  a  man,  now 


STIMULANTS.  i  07 

dead,  who  began  his  career  of  intemperance  by  taking  brandy  in  drops. 
What  the  number  of  drops  was  at  first  I  do  not  know.  Be  did  this 
with  the  intention  of  its  serving  as  a  check  upon  any  excess  into  which 
he  might  be  tempted.  Finding,  however,  as  a  matter  of  coarse,  that 
the  exhilarating  effects  of  his  drops  were  gradually  lessening,  he  in- 
creased the  dose,  and  in  this  way  lie  went  on  practising  a  constant 
deception  upon  himself  until  he  became  a  perfect  sot.  In  the  use  of 
stimulants  in  the  treatment  of  diseases  this  fact  is  of  importance.  It 
shows  that  when  they  are  required  the  dose  must  be  gradually  increased, 
if  you  wish  to  keep  up  a  certain  effect. 

Actual  Condition  of  the  System. — The  effects  of  stimulants  vary  con- 
tinually with  the  varying  condition  of  the  individual.  If  the  stomach 
is  empty,  they  are  much  greater  than  when  it  is  full.  This  is  known  to 
everybody.  Double  the  quantity  of  liquor  of  any  kind  can  be  taken 
after  dinner  than  before.  The  reason  is,  that  the  excitability  of  the 
stomach  is,  to  a  certain  extent,  exhausted  by  the  process  of  digestion. 
This  is  evidenced  by  the  tendency  to  torpor  and  sleep  which  succeeds 
this  process.  A  still  more  striking  illustration  is  met  with  in  persons 
who,  either  from  necessity  or  inclination,  have  fasted  or  kept  themselves 
on  short  allowance  for  any  length  of  time.  In  all  these  cases,  from  the 
accumulated  excitability  in  the  system,  the  smallest  quantity  of  stimu- 
lating food  or  drink  produces  the  most  extraordinary  effect.  The  cele- 
brated Venetian  nobleman,  Cornaro,  who  attained  to  the  age  of  upwards 
of  one  hundred  by  his  abstemious  mode  of  life,  relates  that  he  had  a 
violent  fever  excited,  which  lasted  for  several  weeks  and  threatened  bis 
life,  by  increasing  the  quantity  of  his  daily  allowance  of  food  from  twelve 
to  fourteen  ounces. 

Another  interesting  case  occurred  in  the  history  of  Captain  Bligh, 
who  commanded  the  ship  Bounty.  In  her  voyage  in  1787  to  the  South 
Sea  Islands  to  convey  the  bread-fruit  tree  to  the  West  Indies,  the  men 
mutinied,  and  the  commander  with  eighteen  men  was  sent  adrift  in  an 
open  boat.  In  this  condition  they  performed  the  unparalleled  voyage 
of  4,000  miles  in  the  open  sea.  Their  sufferings  during  this  period  from 
exposure  and  want  of  food  were  dreadful.  They  were  kept  all  the  time 
in  a  state  approaching  starvation.  In  this  state  a  teaspoonful  of  rum 
dealt  out  to  them  occasionally  is  stated  to  have  acted  as  a  powerful  sti- 
mulant in  enabling  them  to  complete  this  extraordinary  voyage  without 
the  loss  of  a  single  individual. 

Another  illustration  of  the  modifying  effect  of  the  actual  condition  of 
the  system  is  to  be  found  in  those  cases  where  the  excitability,  instead 
of  being  accumulated,  has  been  from  some  cause  or  other  exhausted. 
Here  immense  quantities  of  stimulating  articles  can  be  taken  with  little 
or  no  effect.     The  advanced  stages  of  typhus  furnish  many  examples. 


408  MATERIA   MEDIC  A    AND   THERAPEUTICS. 

In  these  states,  it  is  astonishing  what  immense  quantities  of  wine  and 
other  stimulants  have  been  administered  with  but  little  effect. 


STATES  OF  SYSTEM  FAVORABLE  AND  UNFAVORABLE  TO  THEIR  USE. 

As  the  effects  of  stimulants  differ  so  materially  according  to  the  actual 
condition  of  the  system,  it  is  exceedingly  important  to  mark,  if  possible, 
with  some  precision,  those  in  which  they  may  be  used  with  advantage, 
as  well  as  those  in  which  they  may  prove  injurious. 

A  state  of  active  irritation  or  inflammation  of  the  stomach  is  decid- 
edly unfavorable  to  the  use  of  stimulants.  Whenever,  therefore,  this 
state  of  the  stomach  exists,  you  are  to  avoid  these  agents.  In  speaking 
of  irritation  of  the  stomach,  you  are  to  make,  of  course,  a  proper  dis- 
tinction. In  many  cases  this  organ  becomes  exceedingly  sensitive  and 
irritable  without  the  least  inflammation.  You  see  this  in  cases  of  ordi- 
nary sea-sickness ;  in  the  sickness  resulting  from  the  use  of  narcotics, 
tobacco,  &c.  Here  stimulants,  so  far  from  being  objectionable,  are  the 
best  things  that  can  be  used. 

The  existence  of  active  local  irritation  or  inflammation  in  any  other 
part  of  the  system  is  decidedly  unfavorable  to  the  use  of  stimulants,  also 
the  existence  of  general  febrile  excitement.  If  given,  their  effect  must 
be  an  increase  of  vascular  excitement,  and  perhaps  local  congestion. 

I  do  not  wish  you  to  understand  by  this,  that  I  consider  the  use  of 
stimulants  improper  in  every  state  and  stage  of  what  is  commonly  deno- 
minated fever.  On  the  contrary,  in  the  advanced  periods  of  the  disease, 
where  the  energy  of  the  nervous  system  is  exhausted,  and  a  general  col- 
lapse has  taken  place,  this  class  of  agents  is  essential,  and  they  may  and 
must  be  given  in  very  large  quantities,  as  before  stated. 

General  plethora  of  the  system  is  unfavorable  to  the  use  of  stimulants. 
In  this  state  there  is  always  danger  of  some  local  embarrassment,  either 
congestion  or  inflammation,  whenever  anything  hurries  the  circulation. 
Now,  stimulants  quicken  the  circulation  at  a  time  when  the  heart  and 
blood-vessels  are  so  distended  as  to  be  unable  to  carry  the  blood  freely 
through  the  system.  Hence  obstructions  take  place,  and  apoplexies  and 
the  like  result. 

Organic  disease  of  the  heart  and  arteries  is  unfavorable  to  the  use  of 
stimulants.  The  hurry  and  vehemence  with  which  circulation  takes  place 
under  the  influence  of  stimulants  tends  to  increase  organic  disease,  and 
endanger  rupture  of  the  vessels  in  case  of  aneurism. 

From  all  this  the  condition  of  system  favorable  to  the  use  of  stimulants 
is  evident.  It  is  that  in  which  there  is  general  constitutional  debility  or 
nervous  exhaustion,  especially  if  unaccompanied  by  local  inflammation,  or 
embarrassment,  or  organic  disease.  With  these  general  observations  I 
shall,  after  a  word  or  two  on  the  difference  between  stimulants  and  tonics, 


STIMULANTS.  10'J 

pass  at  once  to  tlic  consideration  of  tlie  application  of  these  to  tin:  euro 
of  disease. 

The  points  of  resemblance  between  tonics  and  stimulants  are,  that 
they  both  tend  to  augment  the  vital  powers,  to  increase  muscular  strength, 
and  to  invigorate  every  part  of  the  system.     The  differences  are  : 

Stimulants  act  with  greater  promptness;  their  effects  follow  almost 
immediately  on  their  administration.  Tonics,  on  the  contrary,  manifest 
no  influence  at  all  upon  the  system,  till  they  have  been  used  for  some 
considerable  time.  The  effects  of  stimulants  pass  off  as  promptly  as  they 
are  induced;  while  of  tonics,  as  the  impression  is  slowly  made,  so  it 
passes  away  slowly. 

They  differ  in  the  degree  in  which  they  excite  the  vital  powers.  By 
stimulants  this  excitation  is  very  great ;  vital  power  is  augmented,  and 
vital  functions  are  performed  with  a  degree  of  vehemence,  so  to  speak. 
From  tonics  no  such  effects  result;  the  exaltation  of  the  vital  powers 
which  they  produce  is  moderate ;  no  violent  action  follows  their  use,  nor 
can  this  effect  be  produced  by  any  mode  of  administering  them.  Increase 
the  dose  of  a  stimulant,  and  you  increase  its  stimulating  power ;  increase 
the  dose  of  a  tonic,  and  its  effects  are  no  longer  tonic,  they  are  in  a  high 
degree  irritative. 

Before  passing  to  the  application  of  stimulants  to  the  treatment  of 
various  diseases,  I  will  give  you  a  few  general  rules  for  their  administra- 
tion. This  is  the  more  necessary,  as  there  is  perhaps  no  class  of  medi- 
cines which  vary  so  widely  in  their  operation  according  to  the  mode  in 
which  they  are  given.  This,  indeed,  often  entirely  decides  the  question 
whether  they  are  to  do  good  or  harm,  to  save  or  to  destroy.  Adminis- 
tered judiciously,  there  are  few  remedies  more  valuable.  Given  care- 
lessly, there  are  none  more  dangerous. 

Rules  to  be  observed  in  the  use  of  Stimulants. — Begin  with  small 
doses,  and  increase  them  only  as  they  obviously  fail  of  producing  the 
desired  effect.  In  this  way  you  will  often  get  from  a  moderate  amount 
the  best  effects,  and  you  avoid  the  very  great  evil  of  being  obliged  to 
oppress  the  stomach  by  a  large  quantity.  Change  the  stimulant  as  the 
system  becomes  accustomed  to  it.  When  it  no  longer  responds  promptly 
to  the  impression  of  one  form  of  ardent  spirits,  try  another ;  if  beer  after 
doing  well  for  a  time  loses  its  power,  resort  to  wine,  and  so  on.  You 
will  often  find  that  the  system,  when  it  has  become  quite  insensible  to 
the  impression  of  one  stimulant,  will  be  roused  by  another,  even  though 
feebler  in  its  general  action.  This  shows  a  diversity  in  the  impression 
made  by  different  articles  of  this  class,  and  proves  the  fallacy  of  that 
theory  of  the  operation  of  stimulants  which  gives  to  them  all  a  unifor- 
mity of  action,  and  allows  only  a  difference  in  degree  between  one  and 
another.  If  this  were  so  we  should  need  but  one  stimulant,  and  could 
get  all  the  effects  of  the  class  from  one  individual  article.  Every  day's 
experience  disproves  this  idea. 


410  MATERIA   MEDICA  AND   THERAPEUTICS. 

To  avail  yourself  of  tbe  advantage  to  be  derived  from  following  the 
last  rule,  use  stimulants  uncombined.  Give  one  form,  and  only  one,  till 
tbe  system  ceases  to  respond  to  it,  and  tben  resort  to  anotber  to  be  used 
in  tbe  same  way. 

Practical  Applications  of  Stimulants. — There  is,  perhaps,  no  class  of 
remedies  which  has  been  more  abused  than  the  one  we  are  now  con- 
sidering, and  there  is  none  which  requires  more  discrimination  in  their 
use.  The  reasons  of  this  are  obvious.  The  general  indication  for  which 
they  are  given  is  to  remove  debility,  either  of  some  particular  organ,  or 
of  the  system  at  large.  Now,  debility  may  exist  along  with  many  dif- 
ferent and  opposite  conditions  of  the  system.  It  may  be  apparent,  or  it 
may  be  real.  It  may  be  the  result  of  excessive  action  and  inflammation, 
or  of  deficient  action.  Now,  if  stimulants  be  given  in  these  various  con- 
ditions of  the  system  merely  with  the  view  of  counteracting  debility,  the 
most  opposite  and  disastrous  effects  must  be  produced.  It  is  evident, 
then,  that  the  mere  presence  of  debility  is  no  guide  to  the  use  of  these 
agents.  In  all  cases,  the  accompanying  state  of  the  organs  and  the 
cause  of  the  debility  must  be  taken  into  consideration.  This  shows  the 
necessity  of  extreme  caution  in  their  use.  All  this  will  be  strikingly 
illustrated  in  noticing  some  of  the  diseases  in  which  stimulants  are  pre- 
scribed. 

1.  Fever. — There  is  no  form  of  disease  in  which  there  has  been  a 
greater  difference  of  opinion  in  relation  to  the  use  of  stimulants  than 
in  fever.  While  by  some  they  have  been  freely  used,  and  even  con- 
sidered essential  to  the  cure,  by  others  they  have  been  totally  inter- 
dicted. That  these  opinions  on  both  sides  have  been  carried  to  an  un- 
warrantable extreme  cannot  be  questioned.  The  cause  of  this  difference 
of  opinion  and  practice  is,  that  the  treatment  has  been  deduced  in  too 
many  cases  too  rigidly  from  certain  theoretical  notions  which  have  been 
entertained  in  relation  to  the  nature  of  fever.  Thus  for  example,  by  the 
Brunonians,  fever  was  looked  upon  as  a  •  disease  of  debility,  and  accord- 
ingly stimulants  were  proper  remedies.  On  the  other  band,  the  Brous- 
sains,  discarding  altogether  the  idea  of  the  existence  of  fever  as  an  idio- 
pathic disease,  and  looking  upon  it  as  always  the  result  of  local  inflam- 
mation, considered  antiphlogistic  remedies  as  the  only  ones  proper.  A 
more  enlightened  observation  has  shown  the  fallacy  of  both  these  doc- 
trines. Fever  is  not  to  be  considered  as  a  disease  of  pure  debility,  or  as 
originating  in  local  inflammation,  and  yet  in  the  different  forms  and 
stages  of  it  both  these  may  be  present.  In  its  varied  and  protracted 
career,  fever  presents  phenomena  entirely  different,  and  these  require  a 
corresponding  difference  in  the  treatment.  In  the  early  stages,  where 
the  prominent  symptoms  are — increased  action  of  the  heart  and  arte- 
ries, heat  of  skin,  impaired  secretion — stimulants  are  obviously  improper ; 


STIMULANTS.  1 1  I 

bleeding,  purging,  and  other  antiphlogistics  are  essential,  bul  in  the  pro- 
gress of  tlm  disease,  symptoms  of  sinking  and  collapse  come  on,  and  here 
the  very  free  use  of  stimulants  may  be  required  to  preserve  life.     ] 
will  uot  happen  in  every  case,  and  generally  speaking,  patients  do  \ 
better  even  in  tbe  last  stages  of  fever  without  stimulants;  especial! 
this  the  case  in  the  intermittent   and    remittent  fevers  which  prevail 
throughout  our  country.     In  typhus  the  case  is  widely  different,  and 
stimulants  are  much  more  frequently  required.    In  the  last  stage,  where 
general  torpor  and  collapse  exist,  the  judicious  use  of  stimulants  is  ex- 
ceedingly beneficial,  and  from  the  great  insensibility   that  prevails  we 
arc  frequently  warranted  in  giving  them  in  very  large  quantities.     Both 
the  quantity  given  and  tbe  continuance  of  the  remedy  musl  depend  on 
the  effects  which  it  produces  ;  it  is,  therefore,  essential  that  tbe  patient 
be  carefully  and  intelligently  watched. 

Where  under  tbe  use  of  stimulants  tbe  pulse  becomes  slower  and 
fuller,  tbe  skin  uniformly  warm  and  moist,  the  respiration  more  equable 
and  slow,  tbe  tongue  moist  and  clean,  delirium  abates  and  sleep  follows; 
tbe  stimulants  are  doing  good.  Where  on  the  contrary  the  pulse  is 
quickened,  face  flushed,  heat  augmented,  thirst  and  restlessness  produced, 
and  delirium  either  comes  on  or  is  aggravated,  the  stimulants  are  failing 
of  their  proper  effects,  and  should  be  stopped.  Dr.  Stokes  says  that  the 
use  of  wine  is  indicated  when  in  typhus  the  heart's  impulse  is  diminished 
with  feebleness  or  extinction  of  tbe  first  sound.  This  state  of  the  heart's 
action  is  to  be  noted  by  tbe  stethoscope,  not  by  examination  of  tbe 
pulse. — Dublin  Jour.  1839. 

As  to  tbe  quantity  of  stimulant  that  may  be  required  there  can  be  no 
fixed  rule;  the  effect,  and  not  tbe  quantity,  should  guide  us.  The  pre- 
vious habits  of  the  patient  will  afford  some  indication.  Tbe  particular- 
stimulant  to  be  used  must  also  depend  on  circumstances.  Sometimes 
snake  root  and  volatile  alkali  will  suffice,  then  brandy  in  the  form  of 
grog,  milk  punch,  &c.  <fcc,  must  be  given  with  a  liberal  ba#d.  To  con- 
trol tbe  effects  of  those  poisons  which  operate  by  a  purely  sedative 
influence,  stimulants  may  be  used  with  very  great  freedom,  and  with 
excellent  effect ;  e.  g.  Ammonia  has,  in  this  way,  controlled  tbe  action 
of  tbe  poison  from  venomous  snakes. 

Hemorrhages. — In  no  case  are  stimulants  more  obviously  necessary, 
and  very  seldom  do  they  so  plainly  show  their  curative  powers,  as  in 
rousing  patients  from  tbe  prostration  consequent  on  tbe  loss  of  blood. 
Tbe  most  striking  illustration  of  this  is  tbe  Haemorrhages  after  partu- 
rition. Here  the  prostration  is  frequently  so  great  as  to  require  tbe 
administration  of  large  quantities  of  the  most  potent  stimulants  to  save 
life.  In  some  cases,  even  after  the  haemorrhage  has  ceased,  the  patient 
will  become  pulseless ;  faintness  comes  on,  nausea  and  vomiting  super- 

27 


412  MATERIA    MEDICA   AND   THERAPEUTICS. 

vcne,  and  almost  everything  is  rejected.  Even  wine  will  be  thrown  off. 
In  this  state  of  things  nothing  but  brandy,  judiciously  administered,  will 
answer.  Small  doses  of  this  mixed  with  water,  and  frequently  repeated, 
will  remain  on  the  stomach,  and  support  the  sinking  powers  when 
everything  else  fails.  The  beneficial  effect  of  it  is  to  be  judged  of  by  its 
lessening  the  morbid  frequency  of  the  pulse. 

3.  Delirium  Tremens. — This  peculiar  disease  will  be  noticed  when 
speaking  of  the  effects  of  alcohol  on  the  human  system.  With  regard 
to  the  use  of  stimulants  in  it,  there  is  much  difference  of  opinion.  By 
some  they  are  supposed  to  be  wholly  unnecessary,  while  others  consider 
them  as  essential.  Everything  here  depends  upon  the  precise  character 
of  the  case.  Where  the  patient  is  not  broken  down  by  long  continued 
intemperance,  and  where  there  does  not  appear  to  be  any  particular 
prostration  of  strength,  I  conceive  stimulants  to  be  not  merely  unne- 
cessary, but  injurious.  Moderate  purging,  keeping  the  patient  in  a  dark 
room,  abstracting  all  irritants,  in  the  way  of  company,  &c,  together 
with  the  judicious  and  moderate  use  of  opiates,  will  almost  always  cure. 
In  a  large  majority  of  cases,  this  treatment,  variously  modified  to  suit  par- 
ticular circumstances,  will  answer.  At  the  same  time  cases  may  and  do 
occur,  where  the  general  prostration  is  so  great  as  absolutely  to  require 
some  cordial  or  stimulant  to  support  the  sinking  vitality,  to  preserve 
life  from  moment  to  moment.  These  cases,  however,  do  not  occur  so 
often  as  is  supposed;  and  I  am  inclined  to  think  that  this  complaint,  as 
a  general  rule,  can  be  managed  with  much  less  free  recourse  to  stimu- 
lants than  is  commonly  supposed. 

4.  Dyspepsia. — In  the  whole  range  of  medicine  there  is,  perhaps,  no 
disorder  which  has  given  rise  to  such  various  and  contradictory  treat- 
ment as  this.  The  reason  is  obvious,  when  we  reflect  upon  the  endless 
and  variegate*!  symptoms  to  which  it  gives  rise.  Among  the  agents 
most  commonly  resorted  to  are  stimulants  of  various  kinds.  In  no  dis- 
ease have  they  been  more  abused,  and  in  none  has  their  use  led  to 
more  serious  and  melancholy  consequences.  The  temptation  to  their  use 
on  the  part  of  the  patient  is  always  great  and  present.  Generally  speak- 
ing, they  give  temporary  energy  to  the  stomach  and  to  the  system,  and 
in  this  way  induce  the  patient  to  believe  that  they  are  absolutely  essen- 
tial to  the  process  of  digestion.  Thus  habits  fatal  to  life  and  character 
are  contracted.  Indeed  instances  of  this  kind  occur  so  frequently  that 
it  is  a  question,  not  merely  of  professional  but  of  moral  interest,  whether 
this  class  of  remedies  ought  ever  to  be  prescribed.  Now  it  is  very  evi- 
dent that  a  question  of  this  kind  can  only  be  settled  satisfactorily  and 
correctly  by  understanding  accurately  the  nature  of  the  disease ;  other- 
wise everything  that  may  be  said  in  relation  to  it  amounts  to  little  more 


STIMULANTS.  418 

than  idle  declamation,  tt  is  out  of  ray  province  to  give  yon  anything 
like  a  full  account  of  this  protean  disease.  I  shall  content  myself  with 
such  general  statements  as  will  enable  you  to  judge  how  far  Btimulants 
may  or  may  not  be  useful  and  proper. 

Dyspepsia  consists  essentially  in  a  di'hililal^d  and  disordered  Male  of 
the  stomach.  From  the  sympathy,  however,  existing  between  the  sto- 
mach and  the  neighboring  organs,  such  as  the  intestines,  the  liver,  &Cn 
the  stomach  cannot  long  be  affected  without  involving  these  organs. 
Dyspepsia,  too,  may  originate  from  different  causes,  from  influences  act- 
ing immediately  on  the  stomach,  such  as  excessive  eating  or  drinking, 
or  from  diseases  of  some  neighboring  organ,  as  the  bowels,  the  liver, 
&c,  &c. 

From  all  this  it  is  obvious  that  this  affection  is  necessarily  of  a  mixed 
and  complicated  character,  varying  greatly  in  the  different  forms  and 
combinations  in  which  it  may  present  itself.  Besides  this,  it  is  to  be 
recollected  that  its  general  character  must  be  modified  greatly  by  its 
duration.  At  first  amounting  to  nothing  more  than  functional  disorder 
and  simple  irritation,  it  speedily  assumes  the  character  of  insidious 
inflammation,  and  eventually  terminates  in  chronic  organic  disease.  If 
all  this  be  trnc,  it  is  very  clear  that  no  one  uniform  system  can  be 
applied  to  this  disease.  It  must  vary  with  the  cause  producing  the 
disease,  as  well  as  with  the  extent  to  which  is  has  proceeded. 

The  only  condition  connected  with  this  disease  in  which  stimulants 
can  be  serviceable  or  even  admissible,  is  that  of  simple  debility  of  the 
stomach  and  intestines.  When  this  exists  independent  of  other  disease, 
and  when  there  are  no  febrile  or  inflammatory  symptoms  present,  they 
may  be  used ;  but  even  here  with  moderation,  and  not  unfrequently  the 
patient  gets  along  better  without  them  by  trusting  to  regimen  and  exer- 
cise. Mackintosh  says,  "the  best  diluents  he  can  use  are,  an  infusion  of 
camomile  flowers  and  lemon  peel,  and  wine  and  water ;  stimulants  are 
to  be  commenced  with  great  caution,  and  not  until  the  pain  in  the  epi- 
gastric region  and  heat  of  skin  are  subdued ;  perhaps  the  best  stimulant 
is  cayenne  pepper  with  food,  which  affects  the  whole  bowels  as  well  as 
the  stomach,  and  tends  to  obviate  constipation.  Ginger  tea  will  be  found 
serviceable,  together  with  a  glass  or  two  of  good  sound  wine  once  or 
twice  a  day.  Wine  sometimes,  however,  produces  acidity,  in  which  case 
a  small  quantity  of  brandy  and  water  is  found  an  agreeable  substitute." 
— Practice  of  Physic,  v.  ii.  p.  235.  [Good  wine  is  so  scarce  that  it  is 
little  used,  and  might,  I  believe,  be  banished  altogether.] 

5.  Convalescence. — In  convalescence  from  disease  the  use  of  stimu- 
lants has  been  and  is  still  resorted  to.  By  some,  indeed,  they  are  con- 
sidered essential.  This  is  called  building  up  the  patients,  and  is  as 
regularly  resorted  to  as  the  depletion   and  evacuations  which  precede 


414  MATERIA   MEDICA   AHD   THERAPEUTICS. 

it.  With  much  more  propriety  might  it  be  called  building  up  the  phy- 
sician, for  I  have  known  more  than  one  practitioner  who  owed  a  great 
portion  of  his  business  to  this  practice  of  building  up  his  patients. 
Why  it  should  render  a  physician  popular  is  obvious  enough  :  inde- 
pendent of  the  pleasurable  excitement  which  is  produced  and  repeated 
at  each  repetition  of  the  close,  most  patients  are  anxious  to  see  and  feel 
their  progressive  improvement,  and  this  they  imagine  the  stimulant 
enables  them  to  do.  With  regard  to  this  practice  you  cannot  be  too 
cautious.  In  some  cases  when  disease  has  been  long  protracted,  and 
when  the  powers  of  life  have  been  greatly  prostrated,  gentle  stimulants 
may  be  necessary.  As  a  general  rule,  however,  patients  during  conva- 
lescence will  do  much  better  if  their  recovery  be  trusted  to  the  powers 
of  nature,  along  with  proper  diet  and  exercise,  than  they  will  if  goaded 
by  stimulants.  Their  recovery  may  be  slow,  but  it  will  be  surer  and 
unattended  by  any  injurious  effects.  There  are  two  reasons  more  espe- 
cially why  physicians  should  be  cautious  in  this  matter :  It  renders 
convalescence  more  uncertain.  Stimulants  hurry  the  circulation  and 
drive  forward  vital  action.  Now  when,  as  during  convalescence,  the 
vital  powers  are  weak,  the  over-tasking  them  is  very  apt  to  be  followed 
by  exhaustion,  hence  dangerous  prostration.  But  there  is  another 
danger  from  the  perturbing  influence  of  stimulants  on  the  circulation, 
viz.  the  unequal  distribution  of  the  blood,  leading  to  congestion.  This 
is  especially  to  be  dreaded  where  the  convalescence  is  from  some  local 
phlegmasia,  the  organ  that  has  been  the  seat  of  the  disease  is  in  a  state 
very  favorable  to  the  occurrence  of  congestion  or  even  inflammation. 

The  moral  danger  from  taking  stimulants  during  convalescence  is 
very  great.  Under  no  circumstances  is  their  use  so  seductive,  never 
are  their  immediate  effects  more  pleasant,  never  is  the  call  for  another 
and  another  dram  more  irresistible.'  Sickness,  too,  removes  one  of  the 
great  safeguards  against  the  habit  of  intemperance.  The  fatal  cup  is 
always  taken  as  a  medicine,  and  this  idea  will  hide  from  the  patient  and 
his  friends  the  approaching  danger,  till  the  fatal  habit  is  fixed  for  ever. 
Avoid,  then,  this  dangerous  practice  of  giving  stimulants  during  conva- 
lescence. I  do  not  say  that  it  is  never  necessary  ;  but  you  should 
always  look  upon  it  as  a  necessary  evil,  to  be  got  rid  of  at  the  earliest 
possible  moment.  The  rule  is,  never  give  stimulants  when  your  patient 
is  steadily,  however  slowly,  gaining  ground  ;  if  you  are  sure  he  is  a  lit- 
tle, be  it  ever  so  little,  better  every  day,  trust  to  time ;  far,  far  better  is 
it  that  a  hundred  patients  should  remain  in  bed  a  week  longer  than 
they  would  have  done  had  stimulants  been  used,  than  that  one  should 
by  your  means  have  been  made  a  drunkard. 

In  conclusion  I  would  say  that  deeming  stimulants,  though  of  limited 
use  (and  you  have  seen  that  I  am  most  anxious  to  limit  their  use),  yet 
occasionally  beneficial  and  sometimes  essential,  I  have  not  hesitated  to 


STIMULANTS.  415 

say  so.  I  ara  aware  that  making  this  avowal,  I  expose  myself  to  the 
abuse,  of  the  ultra  temperance  people.  But  I  have  a  duty  to  perform, 
and  besides,  the  cause  of  truth  can  never  lie,  promoted  by  sacrificing 
one's  sense  of  right  to  any  notions  however  popular. 

Gentlemen,  I  am  as  much  in  favor  of  temperaure  as  any  one,  ;in<l 
I  look  upon  the  temperance  reform  as  one  of  the  great  moral  triumph* 
of  the  age.  But  so  good  a  cause  does  not  require  to  be  supported  b)  a 
violation  of  truth  :  the  unchastened  zeal  of  many  so  called  temperance 
men  has  already  done  much  mischief,  and  I  fear  will  do  much  more. 

As  an  illustration  of  this  senseless  zeal  T  may  mention  that  a  young 
man  lately  wrote  a  thesis  in  which  he  laid  down  the  rule  that  alcoholic 
drinks  were  never  to  be  used  ;  that  it  were  belter  to  let  the  patient  die. 
What  a  monstrous  doctrine  this!  The  duty  of  the  physician  is  positive 
and  specific,  to  save  life;  and  yet  according  to  this  notion  he  is,  for  the 
sake  of  a  remote  and  uncertain  consequence,  to  violate  this  duty  and  let 
a  human  being  die,  when  he  could  have  saved  him.  Upon  the  same 
principle,  when  you  see  a  drunkard  or  an  immoral  man  drowning,  you 
may  refuse  to  save  him  because  the  world  would  be  better  without  his 
bad  example.  Such  logic  I  do  not  understand  ;  I  ana  sure  it  is  not  the 
logic  of  the  Bible:  the  whole  spirit  and  authority  of  that  book  go 
to  enforce  the  rule  that  we  are  to  do  our  duty,  and  leave  consequences 
to  <xn  overriding  Providence. 


INDIVIDUAL    STIMULANTS. 

Stimulants  may  be  divided  into  those  which  are  local  in  their  opera- 
tion, or  which  act  more  especially  upon  the  stomach  and  bowels,  and 
those  which  are  general  or  diffusible. 

The  principal  local  stimulants  are  ginger,  calamus,  the  aromatic 
seeds,  cloves,  mace,  cinnamon,  lavender,  peppermint. 

The  general  stimulants  are  alcohol,  ammonia,  camphor,  serpentaria, 
the  peppers. 


-gingek,  {the  rhizoma  of  Zingiber  Officinale). 

Ginger  is  a  native  of  the  East  Indies,  and'  derives  its  name  from  Ginji, 
a  mountainous  district,  where  it  is  particularly  abundant.  It  is  naturalized 
and  cultivated  in  the  West  Indies  and  Mexico.  The  plant  grows  to  the 
height  of  two  or  three  feet,  and  has  a  tuberous  root  in  whieh  the  active 
properties  reside.  This  is  the  part  used.  "  In  the  West  Indies  the 
ginger  crop  is  gathered  in  January  and  February,  after  the  stems  have 
withered.     After  having  been  properly  cleansed  the  root  is  scalded  in 


416  MATERIA   MEDICA   AND    THERAPEUTICS. 

boiling  water,  in  order  to  prevent  germination,  and  is  then  rapidly 
dried."  In  this  process  it  becomes  blackened,  and  this  constitutes  the 
common  black  ginger  of  commerce.  It  is  also  imported  from  the  East 
Indies,  and  is  known  by  the  name  of  the  East  India  ginger.  What  is 
called  the  white  or  Jamaica  ginger  comes  from  Jamaica,  and  is  prepared 
by  selecting  the  best  roots,  and  taking  off  the  epidermis  and  drying 
them  carefully  in  the  sun.  It  is  then  carried  to  England,  from  whence 
it  is  brought  to  this  country. 

Properties. — The  dried  ginger  as  found  in  the  shops  is  round  and 
knotty,  and  about  the  size  of  a  finger.  Externally  it  is  covered  with  a 
dark-colored  and  wrinkled  epidermis.  Internally  it  is  yellowish  white. 
The  white  ginger  differs  from  this  only  in  having  the  epidermis  taken 
off.  It  is  of  a  yellowish  white  color  externally,  and  smaller  in  size  than 
the  black  ginger.  Ginger  yields  a  powder  of  a  yellowish  white  color. 
It  has  a  pungent  aromatic  odor  of  a  peculiar  kind,  and  a  hot  biting 
taste.     Long  exposure  to  the  atmosphere  dissipates  these  properties. 

Effects. — A  pleasant  cordial  stim-nlant  to  the  stomach,  producing  a 
sense  of  warmth  in  the  organ,  with  some  excitement  of  the  system.  It 
is  said  specially  to  stimulate  the  respiratory  and  genital  organs.  Its  use 
is  chiefly  as  a  condiment.  As  a  medicine  it  is  sometimes  given  to  re- 
move flatulence  or  nausea,  or  combined  with  purgatives  to  correct  griping. 
In  the  colic  of  young  children  it  may  be  used  with  advantage. 
,;    Dose. — Powder,  10  grs.  or  more.     Generally  used  in  an  infusion. 


calamus  {the  rhizoma  of  Acorus  Calamus). 

This  is  the  sweet-scented  Jlagr  a  plant  growing  abundantly  in  Europe, 
India,  and  America.  In  the  United  States  it  is  indigenous,  and  is  found 
along  the  borders  of  creeks  and  rivulets.  It  is  also  frequently  an 
inhabitant  of  swamps  and  moist  ground.  The  part  used  in  medicine  is 
the  root.  This  is  from  six  to  twenty-four  inches  long,  rough,,  and 
jointed.  It  runs  horizontally,,  and  is  from  half  an  inch  to  an  inch  thick- 
The  root  is  taken  up  and  simply  dried,  and  is  then  fit  for  use.  By  the 
process  of  drying  it  is  diminished  in  size,  but  neither  impaired  in 
its  smell  nor  taste. 

Properties. — As  found  in  the  shops  the  roots  of  this  plant  are  of  vari- 
ous sizes;  externally  of  a  yellowish  brown  color;  internally  whitish  and 
of  a  spongy  texture.  Sometimes  in  the  root  which  is  found  in  the 
market,  the  external  covering  has  been  entirely  pared  off,  and  nothitio- 
but  the  internal  part  left.  Its  smell  is  pleasant  and  aromatic.  Its  taste, 
when  first  chewed,  sweetish  and  aromatic,  but  afterwards  becoming  bit- 
ter and  acrid. 

The  active  properties  of  calamus  are  extracted  by  boiling  water. 


SMMULANTS.  417 

Effects, — This  plant  bas  been  celebrated  for  its  medicinal  virtue  from 
time  immemorial.  It  appears  to  have  been  known  to  the  GrreeL  and 
Arabians,  as  it  is  noticed  both  by  Dioscorides  and  Avicenna.  Accord- 
ing to  Dr.  Ainslie,  "  it  is  a  very  favorite  medicine  of  the  East  Indies." 

It  is  now  little  used  exeept  as  a  stomachic  and  carminative. 

[The  aromatic  seeds,  anise,  caraway,  cardamoms,  the  peppers,  piper 
nigrum,  capsicum,  and  allspice;  the  condiments,  as  cloves,  lavender, 
peppermint,  <fec,  are  all  remedies  of  much  the  same  character  as  gingi  c 
and  calamus;  their  physical  qualities  are  well  known,  and  their  u  e, 
whether  culinary  or  pharmaceutic,  probably  familiar.  They  need  not 
detain  us. — Ed.] 

GENERAL    STIMULANTS. 

Alcohol. — I  come  now  to  treat  of  alcohol — a  subject  which  in  its 
medicinal  and  moral  relations  is  one  of  very  great  importance,  and  I 
shall  therefore  dwell  upon  it  somewhat  in  detail. 

Origin. — The  juices  of  certain  vegetable  substances,  when  subjected 
to  the  action  of  air  and  moisture,  undergo  what  is  called  vinous  fermen- 
tation, and  yield  various  liquors  possessed  of  stimulating  and  intoxicating 
properties.  Thus,  the  grape  yields  wine,  the  apple  cider,  &c.  Now, 
these  liquors  contain  in  various  proportions  a  peculiar  fluid  called  alcohol, 
along  with  coloring  matter  and  other  principles.  If  they  be  subjected 
to  another  process,  that  of  distillation,  what  is  commonly  called  ardent 
spirits,  is  obtained — brandy,  rum,  gin,  whiskey,  <fec.  These  contain 
alcohol,  mixed  with  water  and  volatile  oil,  <fcc,  and  to  the  quantity  and 
peculiar  nature  of  these  additional  ingredients  are  owing  the  difference 
of  color,  flavor,  &c,  which  characterize  different  forms  of  ardent  spirits. 
By  subjecting  these  again  to  a  second  and  perhaps  third  distillation, 
alcohol  is  obtained  in  its  pure  state. 

When  the  distillation  of  spirit  was  first  invented  is  not  precisely 
known.  The  term  alcobol  is  of  Arabic  origin,  and  hence  it  has  been 
supposed  to  have  been  discovered  by  the  Arabians.  "  The  Greeks  and 
Romans  were  ignorant  of  ardent  spirits;  but  the  use  of  the  still  was 
well  known  in  the  time  of  Geber,  who  lived  in  the  seventh  century ;  he 
describes  very  accurately  the  process  of  distillation  by  the  Alembic,  per 
descendorium  et  filtrum,  in  his  work  entitled  Liber  Investigations 
Magisterii.  The  first  spirits  known  in  Europe  was  made  from  grapes, 
and  sold  as  a  medicine  both  in  Italy  and  Spain  under  the  name  of 
alcohol.  The  Genoese  afterwards  prepared  it  from  grain,  and  sold  it  in 
small  bottles  at  a  very  high  price,  under  the  name  of  aqua  vitce." — 
Thompson  <Dis.  p.  572. 

Pure  alcohol  is  a  colorless  fluid,  has  a  fragrant  odor,  and  a  hot 
pungent  taste.     When  exposed  to   the   atmosphere   it  quickly  evapo- 


418  MATERIA    MEDICA   AND   THERAPEUTICS. 

rates ;  it  is  extremely  inflammable,  burning  with  a  blue,  lambent  flame, 
"without  any  smoke;  it  boils  at  173°;  has  never  been  frozen;  it  dis- 
solves a  great  number  of  saline  bodies,  and  is  the  proper  solvent  for 
many  of  the  proximate  principles  of  vegetables.  It  is  lighter  than 
water;  the  difference  between  them  becoming  greater  in  proportion  to 
the  purity. and  concentration  of  the  alcohol.  Hence,  the  best  test  of  its 
purity  is  its  specific  gravity.  Prepared  in  the  usual  way,  the  specific 
gravity  is  *835,  and  this  is  the  strength  which  it  is  ordered  in  the 
Pharmacopoeia.  By  careful  rectification,  however,  it  may  be  obtained 
of  the  specific  gravity  of  *815,  and  even  '800.  Besides  the  property 
which  alcohol  possesses  of  dissolving  a  great  variety  of  bodies,  it 
prevents  the  putrefaction  of  animal  and  vegetable  substance.  What  is 
called  diluted  alcohol  contains  about  equal  weights  of  alcohol  and  water 
and  the  specific  gravity  is  *935. 

Effects  of  Alcohol. — In  speaking  of  the  effects  of  alcohol,  I  shall  con- 
sider it:  1.  As  a  medicine,  and  2.  As  a  poison. 

In  its  pure  state  alcohol  acts  as  a  powerfully  irritant  and  caustic 
poison.  To  whatever  part  of  the  body  it  is  applied  it  causes  contraction 
and  condensation  of  the  tissue,  and  gives  rise  to  all  the  symptoms  of 
loca  inflammation,  pain,  heat,  redness,  and  swelling. 

In  its  diluted  forms  (as  in  wine,  brandy,  &c.)  when  taken  into  the 
stomach,  it  produces  the  effect  of  stimulating  the  part  to  which  it  is 
applied,  creates  warmth,  and  promotes  the  flow  of  blood.  A  temporary 
excitement  is  thus  produced  in  the  organ,  the  appetite  is  increased,  and 
the  general  power  augmented.  Succeeding  this  local  impression,  the 
general  system  is  affected,  the  action  of  the  heart  and  arteries  is 
increased,  the  brain  and  nervous  system  are  stimulated,  and  there  is  a 
general  feeling  of  increased  mental  power  and  muscular  energy ;  animal 
heat  is  developed,  and  the  various  secretions  are  promoted. 

These  are  the  effects,  when  used  in  moderation,  and  when  it  operates 
kindly.  By  a  law  of  the  animal  economy  excitement  is  always  succeeded 
by  collapse  and  depression.  The  excitement  and  energy  produced  by 
alcohol  are  followed  by  languor  and  debility,  and  these  are  always  in 
proportion  to  the  intensity  of  the  preceding  excitement. 

Now,  there  are  here  two  or  three  circumstances  which  are  worthy  of 
notice. 

1.  The  effects  of  alcohol  are  always  proportioned  to  the  excitability 
of  the  system.  Hence,  in  young  persons,  in  females,  in  nervous  and 
sanguine  temperaments,  they  are  always  the  most  decided. 

2.  The  system  becomes  gradually  accustomed  to  the  impression 
made  by  this  agent,  and  to  produce  the  same  effect  requires  larger  and 
larger  quantities.  9 

3.  In  consequence  of  the  agreeable  excitement  produced  by  alcohol, 
and  the  subsequent  collapse,  a  desire  is  created  for  the  repetition  of  the 


snkoLANTS.  4 19 

close.     This,  if  not  peculiar  to  alcohol,  is  not  the  case  with  anj  other 
medicine,"  except  perhaps  opium. 

As  ;i  medicine,  alcohol  in  its  various  forms  is  an  agreeable  and  power- 
ful stimulant,  and  may  be  resorted  to  in  all  those  cases  where  it  is 
necessary  to  support  the  sinking  powers  oftlie  system. 

In  consequence  of  the  great  abuses  of  this  article,  it  bae  become  a 
question  whether  it  was  justifiable  in  a  physician  to  prescribe  it  in  the 
practice  of  his  profession.  ]Jy  many  the  opinion  was  entertained  that 
it  ought  never  to  be  resorted  to,  and  that  we  could  get  along  very  well 
without  it.  I  was  myself  asked,  not  long  ago,  to  sign  a  paper  declaring 
that  alcoholic  stimulants  were  never  necessary  in  the  treatment  of 
diseases.  I  told  the  gentleman  who  handed  it  to  me  that  /  did  not 
believe  it.  He  urged  me,  notwithstanding,  to  sign  it,  insisting  on  the 
good  it  would  do.  I  told  him  that  I  chose  to  be  governed  by  the 
old  Bible  rule,  never  to  do  evil  that  good  might  come  of  it.  Now,  to 
put  your  name  to  a  thing  you  do  not  believe  is  evil,  and  you  are  never 
justified  in  doing  it.  Follow  the  Bible,  and  you  will  never  go  wrong. 
Questions  of  duty  are  there  resolved,  not  according  to  the  fluctuating 
notions  of  the  clay,  but  by  the  immutable  principles  of  truth. 

As  to  the  question  whether  we  could  get  along  without  alcoholic 
stimulants,  it  is  not  worth  discussing.  We  might  as  well  ask,  could  we 
get  along  without  opium  or  quinine. 

Mode  of  lining  Alcohol  as  a  Medicine. — In  its  pure  state  it  is  never 
taken  internally.  It  is  always  used  in  combination  in  the  form  of  wine 
or  some  other  liquor,  of  which  it  forms  the  active  ingredient. 

1.  Wine. — This  is  of  various  kinds,  differing  not  merely  in  strength, 
but  in  its  effects  on  the  system.  According  to  analysis,  Port  wine 
contains  the  largest  proportion  of  alcohol,  having  about  23  per  cent. 
Madeira  contains  about  22i  per  cent.  Sherry,  18  per  cent.  Claret, 
14a-;  Champagne  (red),  11.30  —  (white),  12.80;  Burgundy,  111. 
Although  champagne  contains  less  alcohol  than  most  of  the  other  kinds 
of  wine,  it  is  proportionately  more  intoxicating  from  the  large  quantity 
of  carbonic  acid  gas  which  it  contains.  Besides  their  strength,  wines 
differ  in  other  respects.  Madeira  contains  a  good  deal  of  acid,  and 
therefore  is  objectionable  where  there  is  acidity  of  the  stomach,  or  where 
there  is  a  disposition  to  lithic  acid  depositions  in  the  urine.  Sherry,  on 
the  other  hand,  contains  little  or  no  acid.  Port  is  astringent. and  tonic, 
hence  it  is  well  suited  to  cases  in  which  the  bowels  are  relaxed.  Claret 
and  Champagne,  on  the  contrary,  are  laxative. 

2.  Ardent  Spirits. — These  do  not  differ  materially  in  strength. 
Brandy  contains  53.39  per  cent. ;  Bum,  53.68 ;  Gin,  51.60.  They 
differ  somewhat  in  their  effects.  Brandy  is  tonic  and  astrino-ent,  Rum 
is  sudorific,  while  gin  and  ivhiskey  are  diuretic,  especially  when  taken 


420  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

•weak ;    the  degree  of  dilution  exerts  a  controlling  influence  over  the 
effects  of  all  forms  of  ardent  spirits. 

3.  Fermented  Liquors. —  Cider  and  Perry  contain  9.87  per  cent.;  Ale, 
8.88  ;  Stout,  6.80.  These,  too,  differ  markedly  in  their  effects,  aside 
from  mere  stimulation.  Ale  and  Porter  are  more  decidedly  tonic;  cider 
diuretic;  .Perry  is  scarcely  known  among  us. 

Now,  of  alcohol  as  a  'poison.  Like  others,  this  may  act  as  a  quick  or 
a  sloiv  poison.  In  the  first  way,  from  taking  too  large  doses  at  one  time. 
In  the  second,  from  continuing  the  use  of  moderate  doses  too  long, 
resembling  in  this  respect  corrosive  sublimate.  Now,  all  these  effects 
ought  to  be  well  understood  by  the  physician,  because  they  are  all  actual 
states  of  disease,  and  call  for  medical  treatment  just  as  much  as  poison- 
ing by  arsenic  or  opium.  I  shall  therefore  describe  them,  and  at  the 
same  time  speak  of  the  mode  of  treatment. 

1.  When  taken  in  a  large  dose  at  once,  alcohol  operates  as  a  deadly 
poison.  Mr.  Brande  injected  proof  spirit  into  the  stomach  of  a  rabbit, 
and  in  five  minutes  he  lay  motionless  and  insensible,  the  respiration  was 
laborious,  and  in  one  hour  and  fifteen  minutes  he  was  dead.  In  animals 
killed  with  this  poison,  the  stomach  is  of  a  cherry  red  color. 

In  the  human  subject,  taking  large  quantities  at  once  (as  persons  do 
who  drink  for  a  wager)  coma  comes  on  suddenly,  the  face  is  sometimes 
livid,  more  generally  ghastly  pale,  the  breathing  is  stertorous,  the  pupils 
sometimes  contracted,  more  commonly  dilated  and  insensible,  and  if 
relief  be  not  offered  speedily,  death  takes  place  sometimes  almost  imme- 
diately, at  others  after  a  few  hours. 

It  is  not  in  this  way,  however,  that  alcohol  is  generally  taken.  It  is 
used  in  smaller  quantities  and  taken  more  gradually,  and  then  it  pro- 
duces various  striking  effects. 

1 .  The  first  of  these  is  intoxication.  This  is  an  effect  peculiar  to 
alcohol.  There  are,  it  is  true,  other  agents  which  produce  a  sort  of 
inebriation,  such  as  opium,  stramonium,  camphor,  nitrous  oxide,  the  inha- 
lation of  sulphuric  ether,  chloroform,  etc.,  but  this  is  different  from  that 
produced  by  alcohol,  both  in  its  general  phenomena,  as  well  as  in  its 
results.  A  paroxysm  of  intoxication  may  be  divided  into  three  stages. 
During  the  first  the  system  is  only  pleasurably  excited.  The  impression 
made  imparts  energy  to  the  mind  and  vigor  to  the  body.  Care  and 
anxiety  are  dispelled  and  a  general  serenity  pervades  the  system.  The 
imagination  becomes  unusually  stimulated,  and  wit  and  eloquence  fre- 
quently flow  forth  in  spontaneous  exuberance.  Such  being  the  first 
effects  of  this  kind  of  excitement,  it  is  not  to  be  wondered  at  that  it  has 
been  so  universally  coveted  by  mankind.  Go  where  you  will — traverse 
the  globe  from  pole  to  pole — and  you  will  not  find  a  people  so  savage  as 
not  to  possess  some  substance  capable  of  yielding  this  pleasure.  It  is 
the  solace  of  the  dejected,  imparts  confidence  to  the  timid,  courage  to 


STIMULANTS.  421 

the  coward.    Could  the  effects  of  alcohol   be  limited   here,  wo  should 
not  have  wo  much  to  regret  in  relation  to  its  use. 
Other  effects  now  follow  of  a  different  character,  and  constitute  the 

second  stage.  In  the  first  stage  the  brain,  though  powerfully  stimulated, 
retains  its  controlling  power,  and  the  mental  faculties,  flhough  highly  ex- 
alted, are  still  under  the  command  of  reason.  Not  so  now.  The  I. nun 
gradually  loses  its  power,  and  a  sense  of  giddiness  is  felt.  The  Bense 
become  perverted — the  vision  is  disordered— objects  change  then 
color  and  become  muftiplied — volition  is  now  impaired  or  losl,  and  all 
the  faculties  become  irregular  in  their  action.  The  drunkard  imagines 
a  thousand  things  which  have  no  existence.  He  is  continually  mistak- 
ing one  person  for  another — incessantly  talking,  while  his  speech  becomes 
thick  and  noisy.  If  lie  attempt  now  to  use  his  muscles,  he  finds  they 
have  lost  their  power,  and  unable  to  support  himself,  he  falls  to  the 
floor.  This  is  the  period  which,  in  fashionable  language,  is  called  get- 
ting under  the  table. 

And  now  comes  on  the  third  stage,  the  third  scene  in  this  disgusting 
drama  ;  if  consciousness  be  still  retained,  everything  is  confusion  and 
chaos — the  blood  circulates  wildly  through  the  brain — the  head  throbs 
and  the  heart  beats  violently — strange  noises  ring  through  the  ears — 
the  faculties,  still  imperfectly  awake,  are  creative  only  of  wild  and  mon- 
strous images.     Finally  all  this  is  overcome  by  sleep. 

Such,  briefly  detailed,  are  the  phenomena  attending  a  fit  of  intoxica- 
tion, or  rather  of  poisoning.  Now  it  is  very  evident  that  it  is  no*,  possi- 
ble for  the  system  to  go  through  all  this  convulsive  excitement  without 
leaving  its  traces  behind  it.  Accordingly  when  the  patient  awakes 
from  his  slumber  he  is  in  no  very  enviable  condition.  The  secretions 
are  all  shut  up— the  tongue  is  furred  and  dry — there  is  excessive  thirst 
— the  skin  hot  and  feverish — the  mouth  foul — the  breath  offensive — the 
nervous  system  in  a  state  of  perfect  exhaustion — the  eye  has  lost  its  fire 
— the  head  aches  and  is  giddy — there  is  sickness  at  stomach  and  a  de- 
gree of  dejection  and  prostration  proportioned  to  the  preceding  excite- 
ment. Nor  is  this  all.  A  person  who  has  been  once  intoxicated  will 
probably  become  so  again.  Every  succeeding  fit  will  increase  his  desire 
for  the  accustomed  stimulus,  while  it  undermines  and  destroys  the  power 
of  resistance. 

Every  case  of  intoxication  does  not  terminate  in  this  way.  Some- 
times apoplexy  and  death  are  the  results;  then  the  drunkard's  deep 
dreamless  sleep  "  knows  no  waking.''' 

Another  of  the  effects  of  the  immoderate  use  of  alcohol  is  the  produc- 
tion of  a  peculiar  disease,  generally  known  by  the  name  of  delirium  tremens. 
Other  names  are  given  to  it,  as  mania  a potu,  mania  tremulentia,  brain 
fever  of  drunkenness.  "When  fully  formed  this  affection  consists  of  a  cer- 
tain degree  of  mental  alienation,  accompanied  with  a  tremulous  motion 


422  MATERIA   MEDICA    AND    THERAPEUTICS. 

of  the  hands  and  frequently  other  parts  of  the  body.  More  commonly 
it  occurs  in  persons  who  have  been  long  accustomed  to  the  intemperate 
use  of  liquor,  and  whose  nervous  systems,  from  that  and  other  causes, 
have  become  greatly  deranged.  In  some  cases,  however,  it  is  brought 
on  by  a  single  fit  of  intoxication,  and  this  I  believe  is  more  likely  to 
happen  when  it  has  been  the  result  of  some  mental  trouble  or  affliction. 
The  symptoms  of  this  affection  are,  loss  of  appetite,  oppression  at  sto- 
mach, followed  by  nausea  and  vomiting,  tremor  of  the  hands  and  mental 
aberration,  the  eye  is  wild  and  the  whole  maimer  furious  and  ungoverna- 
ble, differing,  however,  very  much  in  different  objects.  They  now 
become  the  prey  of  diseased  sensation  and  disordered  imagination. 
Generally  speaking,  fear  and  suspicion  give  the  hue  to  all  their  fancies. 

In  their  incoherent  wanderings  they  imagine  themselves  beset  on  all 
sides  by  knaves  or  enemies — their  business  has  been  ruined,  their  hopes 
are  blasted,  and  even  their  persons  are  in  constant  danger.  If  the  pa- 
tient should  fall  into  a  sound  sleep,  all  this  will  pass  off,  and  he  will  be 
restored  to  the  integrity  of  his  faculties.  In  other  cases  sleep  is  unat- 
tainable, and  then  it  runs  on  to  a  serious  termination.  The  pulse  be- 
comes smaller  and  more  rapid — the  skin  is  cold  and  covered  with  clam- 
my sweat — subsultus  tendinum — coma  or  convulsions  come  on,  and  death 
closes  the  scene. 

It  has  been  the  general  opinion  that  delirium  tremens  results  from  the 
sudden  abandonment  of  liquor,  after  the  immoderate  use  of  it.  Dr. 
Armstrong  is  of  this  opinion.  On  this  subject  Dr.  Channing  states  an 
interesting  fact.  In  the  almshouse  at  Boston,  where  habitual  drunkards 
were  daily  admitted,  and  at  once  deprived  of  liquor  and  kept  on  a  low 
diet,  not  a  single  case  of  delirium  tremens  occurred.  (New  Eng.  Jour. 
v.  viii.  p.  28.) 

But  intoxication  and  delirium  tremens  are  not  the  only  effects  of  the 
abuse  of  alcohol.  Various  diseases  are  produced,  functional  and  organic. 
That  the  stomach  should  be  permanently  deranged  in  its  functions,  from 
repeated  and  excessive  stimulation,  is  not  to  be  wondered  at.  From  the 
law  of  the  system  already  alluded  to,  that  excitement  is  followed  by  col- 
lapse, it  is  a  necessary  consequence  that  the  tone  of  the  stomach  must 
sooner  or  later  be  permanently  impaired,  the  appetite  is  lost,  and  the 
powers  of  digestion  enfeebled  ;  not  merely,  however,  functional  disorder, 
but  actual  organic  disease  takes  place  as  a  necessary  result  of  the  con- 
tinued irritation  and  determination  of  blood  kept  up  in  the  stomach.  We 
have  chronic  inflammation  of  the  stomach  and  scirrhus  of  the  pylorus. 
Besides  the  stomach,  other  organs  also  suffer  eventually  from  the  poison- 
ous influence  of  alcohol.  Among  these  the  most  prominent  is  the  liver. 
From  the  repeated  congestion  to  which  it  is  subjected,  it  eventually 
becomes  fatty,  or  cirrhosed.  Along  with  this  come  ascites  and  jaundice 
from  obstruction  of  the  gall  ducts.     The  kidneys,  too,  are  affected  with 


STIMULANTS.  423 

a  peculiar  form  of  disease,  which  is  generally  accompanied  with  albumi- 
nous urine.     This  is  the  granular  kidney  ofBright. 

Not  merely  the  solids  suffer,  the  fluids  also  become  affected.  That 
alcohol  is  absorbed  into  the  circulation  is  well  established,  and  that  it 
pervades  every  part  of  the  system  is  abundantly  proved  by  the  poison- 
ous breath  of  the  confirmed  drunkard. 

The  mind  eventually  suffers,  and  permanent  mental  aberration  lakes 
place,  showing  itself,  according  to  the  temperament  of  the  patient,  in  the 
ravings  of  furious  mania,  or  in  the  stupidity  of  hypochondriasis.  If  you 
wish  for  information  on  this  subject,  you  have  only  to  analyse  the 
records  of  our  lunatic  asylums,  and  you  will  find  that  a  large  proportion 
of  the  cases  of  insanity  arise  from  this  cause. 


TREATMENT    OF    THE    EFFECTS    OF    EXCESSIVE    USE    OF    ALCOHOL. 

Intoxication. — This  of  course,  resolves  itself  into  two  divisions,  viz. 
the  management  of  the  fit  of  intoxication,  and  the  cure  of  the  habit.  The 
first  is  comparatively  easy,  the  second  infinitely  difficult. 

(«.)  Of  the  Fit, — As  a  general  rule,  the  best  plan  is  to  let  the  person 
sleep  it  out  and  trust  to  the  recuperative  powers  of  nature.  In  some 
cases  the  symptoms  are  of  such  a  nature  as  to  make  it  desirable  to 
break  in  upon  the  stupor  under  which  the  patient  is  laboring.  In  these 
cases  the  remedy  first  to  be  resorted  to  is  vomiting.  This  is  to  be  done 
with  the  double  view  of  emptying  the  stomach,  and  of  making  the  pecu- 
liar impression  on  the  brain  and  nervous  system  which 'we  know  results 
from  this  process.  To  excite  vomiting,  copious  draughts  of  warm  water, 
or  salt  and  water,  or  chamomile  tea,  will  answer  every  purpose.  In 
other  cases  more  powerful  articles  are  required,  and  then  ipecacuanha  or 
the  vitriolic  emetics  may  be  used.  When  the  insensibility  is  so  profound 
as  to  render  the  patient  unable  to  swallow,  the  stomach  pump  may  be 
used. 

Next  to  vomiting,  the  bowels  should  be  unloaded,  and  the  quickest  and 
best  mode  of  doing  this,  of  course,  is  by  means  of  a  stimulating  injection. 
The  common  enema  with  a  couple  of  tablespoonfuls  of  salt  will  answer 
every  purpose. 

Cold  applications  to  the  head  are  also  exceedingly  advantageous,  and 
ought  to  be  continued  for  a  length  of  time.  This  may  be  done  either  by 
cloths  dipped  in  cold  water,  or  by  pouring  cold  water  on  the  head,  as  in 
cases  of  poisoning  by  opium.  If  a  person  is  found  drunk  in  the  streets, 
a  very  good  plan  is  to  have  him  carried  to  the  next  pump,  and  have  cold 
water  poured  on  his  head  for  about  a  quarter  of  an  hour.  Very  generally, 
this  brino-s  him  to  his  senses. 


424  MATERIA   MEDICA    AND   THERAPEUTICS. 

[This,  as  I  before  stated,  is  a  remedy  of  very  great  power,  and  must 
not  be  used  carelessly.  I  bave  known  one  instance  wbere,  used  by  non- 
professional persons,  it  bad  nearly  destroyed  life.  In  old,  broken-down 
drunkards  it  is  full  of  peril ;  tbeir  system  has  so  little  power  of  resist- 
ance that,  if  the  cold  dash  be  carried  far,  reaction  is  impossible.  Use 
this  remedy,  then,  but  use  it  carefully. — Ed.] 

Immersion  of  the  whole  body  in  cold  water  frequently  counteracts 
the  insensibility  produced  by  drunkenness.  This  happens  very  fre- 
quently at  sea.  Sailors  in  a  state  of  intoxication  very  often  fall  over- 
board ;  when  taken  up,  they  are  generally  sober.  Buffon  states  that 
"among  the  savages  in  the  Isthmus  of  America  the  women  throw  their 
drunken  husbands  into  the  rivers,  in  order  the  more  speedily  to  remove 
the  effects  of  intoxication." 

With  regard  to  the  use  of  cold  in  this  way,  proper  discretion  must  of 
course  be  exercised.  If  the  person  has  already  been  long  in  the  cold — 
if  he  is  feeble,  pulse  small,  &c,  nothing  can  be  more  injurious  than  this 
treatment.  To  sustain  the  action  of  col$,  and  be  benefited  by  it," 
requires  a  certain  degree  of  constitutional  vigor  as  well  as  animal  heat. 
If  proper  reaction  does  not  take  place,  it  may  prove  fatal. 

When  apoplectic  symptoms  are  present,  as  they  not  unfrequently  are, 
the  propriety  of  bloodletting  becomes  a  question.  In  the  use  of  this 
remedy,  however,  I  would  advise  you  to  be  cautious.  Cases  may  occur 
in  which  depletion  may  be  very  proper,  but,  generally  speaking,  its 
effects  are  injurious,  and  sometimes  even  fatal ;  at  any  rate,  bleeding 
should  not  be  resorted  to  unless  there  be  present  a  good  deal  of  consti- 
tutional vigor.  It  is  the  observation  of  experience,  that  persons  under 
the  influence  of  liquor  do  not  sustain  well  the  loss  of  blood. 

Acids  have  long  been  celebrated  as  possessing  the  power  of  counter- 
acting the  effects  of  drunkenness.  Vinegar  has,  accordingly,  been  used 
in  large  quantities  for  this  purpose  with  success.    (See  Macnish,  p.  100.) 

{&.)  The.  Cure  of  the  Habit. — This,  I  fear,  is  a  task  almost  hopeless. 
It  depends  not  upon  the  physician,  but  upon  the  patient  himself.  He  can 
do  it,  if  he  possesses  sufficient  fortitude  and  decision  ;  but  unfortunately  the 
habit  of  intemperance  has  already  undermined  so  completely  the  moral 
energy,  without  which  nothing  can  be  done,  as  to  render  the  case  almost 
without  a  remedy.  If  moral  energy  sufficient  be  still  left,  the  patient 
ought  to  be  recommended  to  break  off  at  once  the  use  of  ardent  spirits. 
On  this  subject  I  am  aware  that  a  difference  of  opinion  exists.  By  some 
it  is  supposed  to  be  dangerous  to  break  off  immediately,  and  it  is  therefore 
recommended  to  be  done  gradually  ;  and  various  devices  have  been  sug- 
gested for  doing  this.  This  is  not  meeting  the  enemy  fairly.  It  is  com- 
promising and  sporting  with  him ;  and  lamentable  experience,  I  believe, 
will  prove  that,  in  a  majority  of  cases,  such  a  course  has  proved  abortive. 
In  some  cases,  however,  it  has  proved  successful ;  for  example,  the  cele- 


STIMULANTS.  425 

brated  Dr.  Pitcairn  once  cured  a  Highland  chieftain  who  was  a  patient 

of  his  "by  exacting  a  promise  that  be  would  every  day  drop  a  ■•  rtain 
quantity  of  sealing-wax  into  bis  glass.  He  did  so,  and  at  the  wa  accu- 
mulated tlie  capacity  of  the  glass  diminished,  and   consequently  the 

quantity  of  whiskey  it  was  capable  of  containing.      By  this  plan  be 
cured  of  his  bad  habit  altogether."     (Macnish,  p.  163.) 

Those  who  object  to  the  immediate  and  total  abandonment  of  ardent 

spirit,  do  it  on  the  ground  that  the  system  may  be  brought  into  a  state 
of  dangerous  collapse,  and  delirium  tremens,  &c,  induced.    This  may 

certainly  sometimes  be  the  case,  although  it  does  not  happen  bo  frequently 
as  is  generally  supposed.  To  obviate  anything  of  this  kind,  a  good  plan 
(as  recommended  by  Dr.  Rush)  is  to  substitute  bitter  vegetable  infusion, 
beer,  wine,  and  opium.  lie  says,  "by  the  temporary  use  of  these  -in- 
stitutes for  spirits,  I  have  never  known  the  transition  to  sober  babits  to 
be  attended  with  any  bad  effects,  but  often  with  permanent  health  of 
body  and  peace  of  mind." 

The  first  thing  then  to  be  done  is,  to  endeavor  to  operate  upon  the 
still  remaining  moral  sensibility  in  such  a  way  as  may  induce  the  person 
to  make  a  great  effort  to  break  off  the  habit  at  once.  The  means  by 
which  this  is  to  be  brought  about  are  obviously  as  different  as  the  pecu- 
liarities of  natural  disposition  in  different  individuals — as  their  modes  of 
living — occupation — various  relations  in  life,  &c,  &c.  No  general  rule 
can  be  laid  down  for  the  physician,  except  to  gain  by  every  means  in  his 
power  the  respect  and  confidence  of  the  patient,  so  far  as  to  induce  him 
to  listen  to  his  representations.  When  this  is  gained,  he  maysometimes 
address  the  reason,  or  the  passions,  or  the  fears,  in  such  way  as  to  pro- 
duce a  salutary  influence.  The  first  mode,  then,  of  attempting  to  cure 
the  habit  of  drunkenness  is  addressed  to  the  mind  exclusively. 

The  second  is  addressed  to  the  body,  and  the  principle  upon  which  it 
is  conducted  is  to  associate  with  liquor  something  so  unpleasant  to  the 
taste,  smell,  or  its  general  operation  on  the  system,  as  to  give  the  person 
a  disgust  to  it.  This  is  the  general  principle  on  which  all  the  nostrums 
for  this  purpose  have  been  made.  In  many  cases  they  have  succeeded 
admirably.  Dr.  Rush  says  he  once  cured  a  negro  of  his  fondness  for 
liquor  by  putting  a  few  grains  of  tartar  emetic  in  his  rum.  He  was  so 
sickened  by  it  that  he  thought  he  was  poisoned.  For  two  years  after- 
wards he  could  not  bear  either  the  smell  or  the  sight  of  rum.  Generally 
speaking,  the  cure  in  this  way  is  only  temporary,  unless  aided  by  moral 
restraints.  Thev  are,  however,  exceedino-lv  beneficial  as  giving  time  for 
reflection,  &c. 

2.  Treatment  of  Delirium  Tremens.  —  On  this  subject  I  can  only 
make  a  few  remarks.  Although  various  opinions  are  entertained  in 
relation  to  the  remedies  proper  in  this  curious  affection,  there  cau  be 
no  general  difference  in  regard  to  the  general  principles  upon  which 


426  MATERIA    MEDICA   AND    THERAPEUTICS. 

the  management  of  it  ouo-ht  to  be  conducted.  In  this  disease  there  are 
two  leading  conditions  of  the  system  which  require  to  be  attended  to. 
The  digestive  organs  are  generally  more  or  less  deranged,  and  the  brain 
and  nervous  system  in  a  state  of  irritation.  Our  remedies,  therefore, 
ought  to  be  directed  mainly  to  the  correction  of  these  two  conditions. 

With  respect  to  tbe  first,  as  a  general  rule,  the  best  remedies  that 
can  be  resorted  to  are  purgatives,  and  of  these  the  best  are  a  mixture 
of  rhubarb,  magnesia,  and  mint  water.  By  the  judicious  use  of  these, 
you  unload  the  bowels,  promote  secretion  from  the  liver  and  intestinal 
canal,  determine  from  the  brain,  and  in  all  these  ways  quiet  nervous 
irritation,  besides  preparing  the  system  for  the  subsequent  use  of  other 
remedies.  This,  then,  is  the  first  thing  to  be  done,  and  the  extent  to 
which  it  must  be  carried  is  to  be  regulated  by  the  period  of  the  disease 
and  the  peculiar  symptoms  attending  it.  As  a  general  rule,  purging  as 
well  as  all  other  evacuating  remedies  should  be  limited  to  the  earlier 
periods  of  the  disease. 

Another  class  of  remedies  that  has  been  highly  recommended  for  the 
accomplishing  the  same  object  is  emetics.  These  were,  as  before  stated, 
first  advised  by  Dr.  Klapp  of  Philadelphia,  in  the  year  1817,  and  since 
then  have  been  approved  by  many  distinguished  physicians.  The  objects 
to  be  attained  by  them  are  to  unload  the  stomach,  to  act  on  the  liver 
and  change  the  secretions  from  that  organ,  and  by  the  general  shock 
given  to  the  system  to  produce  a  salutary  impression  on  the  brain  and 
nervous  system  generally.  If,  therefore,  the  stomach  and  liver  be  much 
deranged, •emetics  may  be  valuable  remedies.  Great  care,  however, 
should  be  taken .  in  the  selection  of  the  article  used.  Tartar  emetic  is 
too  powerful  a  sedative,  and  in  many  cases  has  caused  fatal  prostration. 
If  it  be  used  at  all,  two  things  should  be  attended  to  : 

1.  That  the  patient's  strength  be  not  too  greatly  impaired  to  bear  so 
active  an  article. 

2.  It  ought  only  to  be  used  in  the  early  stage  of  the  disease. 
Having  in  this  way  corrected  the  condition  of  the  digestive  organs, 

the  next  thing  to  be  done  is  to  quiet  nervous  irritation  and  produce 
sleep.     This  is  effected  in  two  ways  : 

1.  By  the  abstraction  of  all  kinds  of  stimulants,  and  letting  the 
patient  wear  himself  out  until  he  falls  asleep.  Thus,  by  keeping  a 
patient  in  a  dark  room,  so  arranged  that  he  cannot  injure  himself,  and 
leaving  him  entirely  alone,  he  will  frequently,  after  a  while,  become 
exhausted  and  fall  asleep.  When  sleep  is  attained  the  fit  passes  off  and 
the  patient  recovers. 

2.  Opiates. — On  this  subject  there  is  a  difference  of  practice,  some 
giving  them  in  very  large  doses  and  repeating  till  sleep  is  produced. 
Others  take  a  moderate  course,  using  opiates  occasionally  and  in  smaller 
doses.     As  to  the  merits  of  these  two  plans  : 


KTIMI    I, A  NTS.  -12V 

1st.  If  the  former  succeed,  if  sleep,  deep  and  continued,  re  ult,  the 
cure  is  nearly  certain,  but, 

2d.  [f  it  fail,  the  patient  is  certain  to  he  injured,  and  very  probably 
may  1m;  killed  outright.     Use  it  therefore,  if  at  all,  with  rare. 

[I  have  used  chloroform  with  most  admirable  results  in  tbjs  disease 
calm,  quiet,  and   protracted  sleep  followed    its  administration,  and    the 
patient  was  entirely  rational  on  waking.— Ed.] 

Many  persons  have  been  led  into  the  use  of  liquor  from  the  idea  that 
it  has  a  good  effect  on  the  mental  faculties  ;  and  this  notion  has  been 
sustained  by  the  fact  that  some  men  never  can  make  any  great  mental 
effort  without  the  aid  of  artificial  stimulation,  la  this  way  I  fear  many 
a  aohle  spirit  has  been  wrecked,  habits  of  intemperance  having  beea 
gradually  acquired  under  the  pleasurable  excitement  of  moderate  stimu- 
lation, ending  ia  the  total  prostratioa  of  mind  and  body. 

Now,  with  regard  to  this  idea  of  stimulating  the  mental  faculties,  let 
me  lay  down  a  few  common-sease  precautions.  First  with  regard  to 
the  imagination  : 

If  any  man  takes  liquor  to  stiaiulate  his  iiaaginatioa,  let  him  first  be 
sure  that  he  has  an  imagination  to  stimulate.  This  imaginatioa  is  a 
rare  gift,  vouchsafed  by  God  to  only  a  few  of  his  creatures.  If  a  man 
has  ao  imaginatioa  he  may  stimulate  till  he  is  tired,  without  finding  cor- 
responding results.  He  might  as  well  try  to  draw  water  from  the  fliaty 
rock,  or  strike  fire  froai  a  potatoe.  Reaiember  the  old  philosophical 
axiom,  ex  nihilo  nihil  fit.  Evea  if  a  maa  is  satisfied  he  has  aa  imagiaa- 
tioa  he  should  recollect  that  liquor  only  stiaiulates  it  to  a  certaia  exteat ; 
beyoad  this  it  only  makes  the  aiaa  ridiculous;  for  the  imaginatioa,  sub- 
liaie  aad  soaring  as  it  is,  requires  to  be  well  balanced.  Recollect,  if  alco- 
hol stimulates  the  imagination,  it  impairs  the  judgment  aad  clouds  the 
reasoaiag  faculties.  Now,  it  is  aot  imagination,  but  judgment  and  rea- 
son, which  is  required  in  the  grave  business  of  life.  In  the  practice  of 
our  own  profession,  especially,  we  want  no  flights  of  fancy  :  we  want 
sound  judgment  and  plain  common  sense ;  we  do  not  want  a  man  in  the 
clouds,  we  want  him  on  terra  firm  a,  and  therefore  physicians,  above  all 
others,  should  be  careful  how  they  go  ballooning  it  in  the  air.  Rely  on 
it  their  patients  will  not  follow  them. 

Alcohol  can  only  stimulate  the  faculties,  it  cannot  create  them ;  it 
must  stimulate  a  man's  faculties  such  as  they  are.  If  he  has  mind  it 
may  develop  that,  to  be  sure ;  but  if  he  is  naturally  stupid,  it  will  be 
just  as  sure  to  develop  his  stupidity.  It  can  do  nothing  more.  There 
is  an  old  maxim,  in  vino  Veritas,  which  is  generally  translated  to  meaa, 
that  under  the  influence  of  wine  a  man  speaks  the  truth ;  but  it  means 
a  great  deal  more.  Its  true  meaniag  is,  that  uader  the  iafluence  of 
wine  a  man's  true  character  is  developed.  That  is  the  maxim.  ^\  iae 
acts  like  aitrous  oxide  gas.     Hence  it  is  that  when  a  knave  wants  to 

2S 


428  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

take  advantage  of  another  man  and  find  ont  his  true  character,  he  tries 
to  get  him  under  the  influence  of  liquor.  Let  a  man,  therefore,  beware 
how  he  suffers  himself  to  be  duped  in  this  way.  The  truth  is,  gentle- 
men, the  less  a  man  in  health  has  to  do  with  alcohol  the  better.  To 
the  young  this  is  peculiarly  applicable.  Their  blood  courses  rapidly 
enough  in  their  veins  already  without  any  stimulation.  In  the  ordinary 
business  of  life  the  great  thing  is  to  keep  cool  and  collected,  and  when 
great  enterprises  are  to  be  undertaken  let  the  enterprise — let  the  occa- 
sion be  the  stimulus.  Do  you  think  Napoleon  or  Wellington  needed 
any  other  stimulus  than  the  great  stake  for  which  they  were  contending 
at  the  battle  of  Waterloo  ?  Look  even  at  the  picture,  disgraceful  in 
some  respects,  but  instructive  in  others,  presented  by  the  recent  pugi- 
listic combat  in  our  country.  Read  the  account  of  the  training  which 
Tom  Hyer  and  Yankee  Sullivan  underwent,  and  see  if  liquor  was  one 
of  the  aids  to  which  they  resorted  ?  I  make  these  remarks,  gentlemen, 
not  so  much  for  yourselves,  but  for  the  sake  of  the  patients.  Judicious 
advice,  cautiously  given,  has  saved  many  a  man  from  ruin. 

Aqua  Ammonia. — Aqua  ammonia  is  water  holding  in  solution  am- 
moniacal  gas.  Water  is  capable  of  holding  a  third  of  its  weight  of  gas, 
or  430  times  its  volume,  and  increases  in  bulk  about  two-thirds.  The 
aqua  ammonia  of  the  shops,  however,  does  not  contain  this  proportion, 
but  varies  according  to  the  mode  of  preparation. 

Properties. — Aqua  ammonia  is  a  colorless  liquid,  with  a  caustic  alka- 
line taste,  and  a  pungent  odor.  Turmeric  paper  when  held  over  its 
fumes  is  turned  to  reddish  brown.  It  is  lighter  than  water,  and  its 
strength  varies  with  its  specific  gravity.  It  readily  attracts  carbonic 
acid  from  the  atmosphere  if  not  kept  in  tight  bottles.  It  unites  with 
oils,  and  forms  liquid  soaps  or  liniments.  Sp.  gr.  varies  from  880  (aq. 
amnion,  fortiss).  to  960. 

Effects. — In  its  local  action  aqua  ammonia  is  irritant,  whatever  be 
the  part  to  which  it  is  applied,  the  degree  of  irritation  varying  with  the 
strength.  When  applied  to  the  skin,  if  of  any  strength,  it  causes  red- 
ness, heat,  pain,  and  eventually  actual  vesication.  If  held  under  the 
nostrils,  its  fumes  produce  irritation  of  the  mucous  membrane  of  the 
eye,  of  the  nostrils,  and  if  inhaled  a  similar  effect  is  produced  upon  the 
air  passages.  Taken  into  the  stomach  in  small  quantities,  it  produces  a 
slight  sense  of  warmth  in  the  mouth,  throat,  and  epigastric  region.  In 
large  quantities,  it  acts  as  an  irritant  poison.  In  its  remote  action  it 
produces  the  effects  of  a  stimulant ;  the  pulse  is  rendered  fuller  and 
more  frequent ;  the  muscular  and  nervous  power  of  the  system  is  aug- 
mented ;  the  heat  of  the  surface  is  increased,  while  a  tendency  to  per- 
spiration is  induced. 

From  this  combination  of  properties,  it  is  an   article  of  great  value, 


STIMULANTS.  429 

and  may  be  used  with  advantage  in  many  cases  where  a  prompt  and 
efficient  stimulant  is  required.     From  the  tendency  which  itia    to 
on  the  skin,  it  may,  as  well  as  the  carbonate,  be  used  frequently  in 
febrile  affections  at  a  much  earlier  period  than  many  other  stimulant  . 

Mode  of  Admimstration. — from  five  bo  ten  drops  may  be  given  in  a 
cup  of  cold  water  or  milk,  and  repeated  every  two  or  three  hour 
©ftener,  as  it  is  very  evanescent  in  its  operation. 

Ammonia  lias  been  given,  and  in  a  few  cases  with  success,  to  cure 
the  bite  of  venomous  snakes. 

Carbonate  of  Ammonia. — This  salt  is  prepared  by  triturating  mu- 
riate of  ammonia  and  carbonate  of  lime  together,  and  then  subliming 
from  a  retort  into  a  cold  receiver. 

Properties. — When  recently  prepared  it  is  in  colorless,  translucent 
masses,  about  two  inches  thick,  moderately  hard,  and  of  a  striated  and 
crystalline  appearance.  Its  smell  is  pungent,  and  its  taste  sharp  and 
penetrating,  "Turmeric  paper  when  held  over  it  is  turned  of  a  red- 
dish-brown color  by  the  ammonia,  which  escapes."  It  is  soluble  in 
four  times  its  weight  of  cold  water.  By  boiling  water  or  alcohol  it  is 
decomposed  with  effervescence.  When  exposed  to  the  atmosphere  it 
gradually  loses  its  smell,  becomes  opaque  and  friable,  and  is  converted 
into  the  bicarbonate. 

Effects  on  the  System. — Carbonate  of  ammonia  is  a  local  as  well  as  a 
general  excitant.  Smelling  and  inhaling  its  vapor  cause  irritation  of 
the  mucous  membrane  of  the  nose,  larynx,  and  trachea.  When  swal- 
lowed in  moderate  doses,  it  produces  no  obvious  local  effects;  in  larger 
doses  it  proves  emetic,  and  in  still  larger  doses  it  causes  irritation,  pain, 
and  sometimes  actual  inflammation  in  the  stomach.  In  its  remote 
action  on  the  system  it  increases  the  force  and  frequency  of  the  pulse, 
and  operates  on  the  skin  as  a  diaphoretic. 

[It  is  the  stimulant  for  extreme  prostration  after  uterine  hemorrhage ; 
of  the  many  valuable  practical  hints  for  which  I  am  indebted  to  my  old 
master,  the  late  Dr.  Joseph  Parrish  of  Philadelphia,  no  one  has  been  of 
more  value  to  me  than  the  emphatic,  "  Pour  down  the  volatile  alkali  as 
fast  as  she  can  swallow  it,"  in  a  case  of  tremendous  uterine  hemorrhage. 

"  Peace  to  the  good  man's  memory;  let  it  grow 
Greener  with  years,  and  flourish  in  the  lapse  of  ages.'" — Ed.] 

Mode  of  Administration. — The  best  forms  of  giving  this  article  are 
in  pill  or  in  solution.  From  its  volatile  nature  it  should  never  be  given  iu 
powder.  The  pill  may  be  made  with  some  vegetable  extract,  and  should 
be  kept  in  a  tight  bottle.  [The  dose  is  from  fiyejo  ten  grains  every  two 
or  three  hours.     The  Volatile  julep — carb.  ammonia  5  i,  pulv.  gum.  Ara- 


430  MATERIA   MEDICA   AND   THERAPEUTICS. 

bic.  3  ij — sacch.  alb.  3  ij,  water  six  ounces,,  is  the  form  I  use.    The  dose 
is  a  tablespoonful.] 

As  an  emetic  it  is  used  sometimes  in  paralysis — dose  grs.  xxx. 

Camphor. — This  is  a  substance  found  in  a  great  number  of  vegetables, 
such  as  peppermint,  sage,  thyme,  &c,  from  which  it  is  obtained  by  distil- 
lation. The  camphor  of  medicine,  however,  is  obtained  from  the  Cam- 
phora  officinarum,  a  large  tree,*  which  is  a  native  of  China  and  Japan. 
The  camphor  is  obtained  from  the  leaves  and  twigs,  which  are  first 
steeped  and  boiled  in  water,  from  which  it  is  sublimed.  In  this  state  it 
is  the  coarse  camphor  imported  into  Europe,  where  it  is  afterwards  puri- 
fied by  resublimation. 

Another  kind  of  camphor  is  obtained  from  the  Dryabalanops  Carti- 
phora,  a  tree  of  great  size  growing  in  the  forests  of  Sumatra.  In  .this 
tree  the  camphor  exists  in  concrete  masses  of  considerable  size  in  the 
trunk  of  the  tree,  from  which  it  is  obtained  by  splitting  it.  By  the  Chi- 
nese this  is  considered  as  superior  to  the  other,  but  it  is  not  exported  to 
Europe- 
Camphor  was  unknown  to  the  Greek  and  Roman  physicians,  and  we 
are  indebted  for  our  first  knowledge  of  it  to  the  Arabians.  With  the 
Chinese  physicians  it  is  a  very  favorite  remedy. 

Camphor  is  a  concrete  substance,  of  a  white  color,  semi-transparent, 
and  capable  of  assuming  a  crystalline  form ;  it  is  tenacious  and  some- 
what unctuous  to  the  touch  ;.  though  brittle,  it  is  somewhat  ductile, 
and  therefore  not  easily  pulverized ;  smell  penetrating  and  fragrant ; 
taste  bitter  and  pungent;  specific  gravity  0.9881.  It  is  very  vola- 
tile, and  in  warm  weather  evaporates  very  rapidly  by  simple  exposure 
to  the  air.  It  is  highly  inflammable  ;  burns  with  a  brilliant  flame  and 
much  smoke,  but  does  not  blacken,  and  leaves  no  residue. 

In  water  very  sparingly  soluble,  an  ounce  dissolving  not  more  than 
half  a  grain.  It  imparts,  however,  both  its  odor  and  taste  to  water,  and 
may  be  suspended  in  it  in  large  quantity,  by  means  of  mucilage,  sugar, 
or  yolk  of  eggs.  In  alcohol,  ether,  and  the  oils,  both  essential  and  ex- 
pressed, it  is  soluble.  Sulphuric  and  nitric  acids  dissolve  it,  but  it  is 
ao-ain  separated  by  the  addition  of  water.  Its  most  powerful  solvent  is 
strong  acetic  acid.  The  alkalies  have  no  effect  upon  it.  With  the 
hardest  resinous  substances  it  unites,  and  converts  them  into  a  soft  tena- 
cious mass.  By  distillation  with  nitric  acid  it  forms  camphoric  acid.  It 
is  composed  of  1  eq.  camphagin  (C.  20  H  14)  and  two  of  water. 

When  given  in  moderate  doses,  the  first  effect  is  to  produce  slight 
exhilaration,  and  to  increase  somewhat  the  heat  and  strength  ;  after  this 
it  quiets  irritation,  allays  spasm,  and  causes  a  tendency  to  sleep.    When 

*  Mr.  Abeel  saw  a  tree  twenty  feet  in  circumference,  fifty  feet  high,  and  having 
branches  nine  feet  in  circumference. 


S7IMULANTS..  481 

given  in  large  doses  it  causes  great  anxiety — vertigo,  tremors,  eoldl 
of  skin,  convulsions,  and  death. 

From  its  effects  on  tlie  nervous  system,  it  lias  been  used  by  BOme  as 
an  habitual  stimulant  like  alcohol  or  opiuna.  A  case  i-  related  of  a 
female  who,  from  "  the  casual  application  of  camphor  as  a  remedy  for 
toothache,  contracted  a  fondness  for  it  so  fascinating  and  irresistible  that 
she  at  length  consumed  it  in  large  quantities,  and  could  Dot  I":  induced 
to  relinquish  it  by  all  the  remonstrances  of  her  friends,  or  her  own  con- 
viction of  its  pernicious  consequences." 

[I  have  known  a  similar  case. — Ed.] 

Camphor  is  a  special  stimulant  of  the  genito-urinary  apparatus  ;  in 
moderate  doses  augmenting  the  energy  of  these  functions,  causing  volup- 
tuous dreams,  erections,  &c,  also  ardor  urinse.  <;<>ur.h  thought  it  espe- 
cially useful  in  controlling  uterine  irritation,  dysmenorrhea,  irriv 
uterus,  <fec.  It  is  often  used  in  typhus,  and  by  some  supposed  to  have 
great  power  in  controlling  subsultus  tendinmn.  It  is  very  useful  in 
hysteria  and  the  kindred  affections  as  a  cslmant.  It  is  much  em- 
ployed in  certain  forms  of  melancholia  to  relieve  despondency,  cause 
mental  quiet,  and  produce  sleep.  Especially  is  this  true  when  the  men- 
tal disease  has  any  connexion  with  the  sexual  organs,  as  puerperal  mania, 
nymphomania. 

Externally,  camphor  is  very  extensively  employed  in  solutions,  both 
in  oil  and  alcohol,  in  sprains,  chronic  rheumatism,  indolent  enlargement 
of  the  glands,  &c. 

3£ode  of  Administration. — Camphor  is  given  in  pill  in  dose  from  five 
to  twenty  grains;  also  in  emulsion,  made  by  rubbing  it  up  with  sugar, 
gum  arabic,  and  water.  Its  suspension  is  rendered  more  complete  by 
adding  a  little  myrrh. 

Phosphorus. — This  simple  substance  was  first  discovered  iu  human 
xirine  in  the  year  1699  by  Brandt,  an  alchemist  of  Hamburg.  In  1769 
a  Swedish  chemist  by  the  name  of  Gahn,  discovered  it  in  bones,  in 
which  it  exists  in  combination  with  oxygeu  and  lime,  forming  the  phos- 
phate of  lime.  In  various  combinations  it  is  found  in  the  animal,  vege- 
table, and  mineral  kingdoms.  There  are  various  modes  of  obtaining  it: 
by  taking  phosphoric  acid  (which  is  procured  by  decomposing  bones  by 
sulphuric  acid)  and  mixing  it  with  charcoal,  and  then  distilling  in  an 
earthen  retort.  As  soon  as  the  retort  acquires  a  red  heat,  a  substance 
of  a  reddish  color  comes  over,  having  very  much  the  appearauce  of  wax. 
This  is  received  into  water.  During  this  process  the  phosphoric  acid  is 
decomposed;  the  oxygen  uniting  with  the  charcoal,  while  the  phospho- 
rus is  volatilized. 

Properties. — Phosphorus  is  a  semi-transparent  solid,  of  a  yellowish 
color  and  a  waxy  appearance ;  it  is  without  taste,  and  has  a  garlic  smell. 


432  MATERIA   HEDICA   AND   THERAPEUTICS. 

In  consequence  of  its  great  inflammability,  it  requires  to  be  kept  under 
water.  In  water  it  is  insoluble ;  in  alcobol  and  the  oils  it  is  soluble,  and 
in  ether  much  more  so. 

Effects  on  the  System. — Of  all  the  stimulants,  phosphorus  is  one  of  the 
most  prompt  and  energetic.  Taken  in  moderate  doses  it  produces  a 
sense  of  warmth  in  the  stomach,  together  with  a  very  powerful  general 
excitement,  quickens  the  circulation,  increases  the  energy  of  the  nervous 
and  muscular  systems,  augments  the  animal  heat,  promoting  at  the  same 
time  all  the  secretions,  especially  those  of  the  skin  and  kidneys,  and 
exciting  the  venereal  appetite.  In  larger  doses  it  causes  uneasiness  and 
burning  in  the  stomach,  together  with  general  feverishness  of  the  system. 
In  still  larger  doses  it  produces  ail  the  effects  of  a  virulent  corrosive 
poison. 

In  the  use  of  this  article  the  greatest  caution  should  be  exercised. 
Even  very  small  doses  have  in  some  instances  destroyed  life. 

3fode  of  Administration. — The  form  in  which  this  medicine  is  pre- 
scribed is  a  matter  of  great  importance.  In  substance  it  should  never  be 
given,  inasmuch  as  it  frequently  acts  as  a  mere  caustic,  producing  violent 
inflammation  of  the  stomach  and  bowels. 

The  best  forms  in  which  it  can  be  given  are  in  solution,  either  of 
sulphuric  ether  or  some  fixed  oil.  To  prepare  the  first,  eight  grains  of 
phosphorus  are  dissolved  in  one  ounce  of  sulphuric  ether.  The  addition 
of  a  small  quantity  of  the  essential  oil  of  cloves,  according  to  Lobstein^ 
renders  it  still  more  uniform  and  safe  in  its  action.  Of  this  preparation 
four  or  five  drops  may  be  given  two  or  three  times  a  day,  either  on 
sugar  or  some  spirituous  tincture.  In  this  way  about  one  sixteenth  of  a 
grain  is  taken  at  a  dose. 

An  objection  has  been  urged  to  this  preparation  on  the  ground  that 
when  introduced  into  the  stomach  the  heat  of  that  organ  may  cause  the 
ether  to  evaporate  and  leave  the  phosphorus  in  a  separated  state,  and 
thus  cause  irritation  and  inflammation  of  that  organ.  A  solution  of 
phosphorus  in  fixed  oil  is  therefore  preferred.  This  is  prepared  by 
putting  one  ounce  of  phosphorus,  cut  into  very  small  pieces,  into  a  flask 
with  a  ground  stopper,  and  adding  sixteen  ounces  of  oil  of  olives  or 
almond  oil ;  let  this  digest  in  a  dark  place  for  fifteen  days,  then  decant, 
and  render  it  aromatic  by  the  addition  of  a  few  drops  of  the  essential 
oil  of  bergamot.  After  being  prepared,  it  should  be  kept  in  a  well 
stopped  bottle,  excluded  from  the  light.  From  twenty-five  to  thirty  drops 
of  this  may  be  given  in  the  twenty-four  hours,  in  some  mucilaginous 
vehicle,  and  may  be  continued  for  four  or  five  days. — (Magendie's 
Formulary.) 


\  K  It  VINES. 


These  are  usually  denominated  Antispasmodics,  and  may  be" cod 
dercd  as  stimulants  acting  specially  on  the  nervous  system.  The  term 
antispasmodic,  as  designating  a  class  of  medicines,  is  objectionable  on  a 
variety  of  accounts.  In  the  first  place,  it  is  not  at  all  descriptive  of  the 
effects  of  these  agents  on  the  living  system,  but  views  thorn  simply  as 
correcting  a  single  morbid  condition  of  that  system.  In  the  second 
place,  spasm  arises  from  such  a  variety  of  causes  that  the  term  antispas- 
modic is  equally  applicable  to  as  great  a  variety  of  agents,  all  differing 
from  one  another  in  their  effects  on  the  system.  In  fact,  it  has  led  to 
the  empirical  use  of  them  by  supposing  them  capable  of  controlling 
spasms. 

By  nervines  are  meant  a  class  of  agents  which  produce  a  stimulant 
impression  on  the  nerves,  without  being  followed  by  the  insensibility 
which  attends  the  operation  of  narcotics. 

EFFECTS    ON    THE    SYSTEM. 

Most  of  the  agents  of  this  class  are  remarkable  for  their  peculiar 
smell  and  volatility.  In  consequence  of  this,  their  mere  odor  produces  a 
certain  effect  on  the  system.  When  taken  internally,  in  moderate  doses 
they  stimulate  the  nerves  of  the  stomach  and  intestines.  The  local  im- 
pression thus  made  is  not  equally  manifest  in  all  cases.  In  some  a  sense 
of  heat  and  excitement  is  produced  in  the  stomach;  in  others  a  tonic 
and  cordial  sensation  only ;  while  in  others  again  little  or  no  sensible 
effect  is  occasioned. 

The  impression  is  speedily  diffused  to  other  parts  of  the  system.  The 
whole  nervous  system  is  more  or  less  impressed.  The  vascular  svstem 
is  excited,  and  the  pulse  becomes  more  frequent  and  fuller.  These 
effects,  however,  are  not  invariable. 

The  bowels  are  differently  affected;  while  in  some  cases  they  are 
moderately  relaxed,  in  others  no  effect  is  produced  on  them.  'As  already 
stated,  these  agents  do  not  produce  any  of  the  stupor  and  insensibility 
which  characterize  narcotics.  Some  of  them  are  supposed  to  induce  a 
tendency  to  sleep,  but  they  do  this  only  so  far  as  they  relieve  the  system 


434  MATEKIA    MEDICA    AND   THERAPEUTICS. 

from  pain  and  other  morbid  symptoms  for  which  they  may  be  pre- 
scribed. 

Most  of  the  articles  of  this  class  are  absorbed  into  the  circulation,  and 
their  odor  can  be  recognised  in  the  various  secretions. 

The  effects  of  this  class  of  agents  are  all  produced  very  quickly.  In 
this  respect  they  differ  from  a  great  proportion  of  other  medicinal 
agents,  and  they  are  very  transient,  and  therefore  to  keep  up  a  certain 
effect  they  require  to  be  repeated  at  short  intervals. 

There  is  no  class  of  agents  where  purity  is  of  more  importance  than 
the  one  we  are  considering.  Unless  they  are  pure,  little  or  no  effect  is 
produced  by  them,  and  it  is  from  this  cause  no  doubt  that  so  much  of 
the  discrepancy  in  relation  to  their  effects  has  arisen.  There  are  various 
ways  in  which  the  quality  of  these  articles  may  be  changed.  In  the 
first  place,  by  long  keeping,  they  lose  their  odor,  and  with  this  much  of 
their  active  power.  In  the  second  place  by  actual  adulteration.  This 
is  especially  the  case  with  such  articles  as  musk  and  castor,  the  price  of 
which  is  very  high,  and  therefore  the  temptation  to  adulterate  propor- 
tionably  great. 

From  the  stimulant  operation  of  these  agents,  they  are  contra-indi- 
cated in  all  cases  in  which  there  is  great  plethora  or  inflammatory 
action.  As  a  general  rale,  too,  they  ought  never  to  be  prescribed  until 
after  the  bowels  have  been  properly  evacuated.  It  is  only  after  due 
preparation  of  the  system  that  these  can  be  used  with  advantage — and 
if  thus  used  they  will  do  much  more  than  might  otherwise  be  expected. 


DISEASES    IN    WHICH    NERVINES     ARE    APPLICABLE. 

Nervines  acting  as  stimulants  to  the  nervous  system  are  used  mainly 
for  the  purpose  of  exciting  that  system  and  controlling  spasm.  They 
are  accordingly  given  in  diseases  characterized  by  impaired  nervous 
energy  and  spasm. 

A  condition  of  the  System  characterized  by  Impaired  Nervous  Energy 
may  be  induced  by  whatever  has  a  tendency  to  debilitate  and  exhaust. 
Profuse  evacuations  of  various  kinds,  and  protracted  disease,  are  the 
most  common  causes  of  it.  Although  in  most  cases  of  this  kind  a 
judicious  course  of  ordinary  tonic  treatment  is  the  most  efficient  that  can 
be  adopted,  yet  advantage  may  frequently  be  derived  from  the  specific 
action  of  some  of  the  agents  of  this  class.  In  the  nervous  debility  which 
succeeds  disease,  valerian  sometimes  operates  admirably  in  steadying  the 
nerves.  In  the  advanced  periods  of  fever,  musk  is  a  stimulant  which  is 
frequently  advantageous.  By  Dr.  Graves  it  is  highly  recommended  in 
those  cases  in  which  congestion  of  the  brain  is  apprehended  and  yet  a 
stimulant  is  required. 


NERVINES.  485 

i  Spasmodic  Diseases. — These  are  tin:  diseases  in  which  thii  cla  of 
agents  are  specially  recommended.  A  very  little  a<  piaintance  with 
their  history  will,  however,  show  that  in  a  large  majority  of  cases  tl 
have  done  but  little  good,  and  indeed  it  is  not  to  be  expected  thai  thej 
should.  Spasm  is  a  morbid  condition,  depending  upon  such  a  variety 
of  causes,  and  accompanied  with  such  differenl  and  even  opposite  states 
of  the  system,  that  it  is  impossible  any  one  set  of  remedies  should  have 
a  specific  control  over  it.  And  yet  antispasmodics  have  in  fad  been 
invested 'with  this  power.  That  they  should  have  disappointed  such 
expectations  is  by  no  means  wonderful.  Let  us  briefly  review  some  of 
these  diseases. 

Epilepsy. —  The  causes  which  produce  this  curious  disease  arc  various. 
They  maybe  advantageously  divided  into  those  which  act  immediately  on 
the  brain,  and  those  which  act  primarily  on  some  other  parts  of  the  system 
and  secondarily  on  the  brain.  Under  the  first  may  be  ranged  various  me- 
chanical causes  producing  pressure  on  the  brain,  such  as  malformation  of  the 
cranium,  injuries  of  the  same,  depression  of  bone,  tumors,  &c,  an  overload- 
ed state  of  the  vessels  and  effusions  in  the  brain,  strong  mental  emotions. 
Under  the  second  may  be  arranged  intestinal  irritations  of  various 
kinds,  more  especially  the  irritation  caused  by  worms,  biliary  concre- 
tions, calculi  in  the  kidneys  and  bladder,  acrid  substances  introduced 
into  the  stomach,  the  suppression  of  accustomed  evacuations,  and  the 
like.  In  the  condition  of  the  system,  too,  there  is  a  wide  difference. 
While  in  some  cases  it  is  plethoric,  in  others  it  is  marked  by  general 
debility.  Now  it  is  evident  that  arising  from  such  various  and  opposite 
causes  the  same  mode  of  treatment  cannot  be  uniformly  applicable.  It 
is  idle  to  suppose  that  any  remedies  possess  a  specific  power  of  con- 
trolling epileptic  spasm  or  convulsion.  Experience  has  abundantly 
proved  this.  The  general  management  of  the  disease  divides  itself  into 
that  which  is  required  during  the  paroxysm  and  that  during  the  inter- 
vals. During  the  first,  little,  if  anything,  can  be  done  with  much  effect, 
and  the  great  object  is  during  the  intervals  to  endeavor  to  correct  the 
condition  of  the  system  upon  which  the  recurrence  of  the  paroxysms 
appears  to  depend.  If  the  disease  is  connected  with  an  overloaded 
state  of  the  blood-vessels,  venesection  and  evacuants  are  to  be  resorted 
to.  If  it  depend  upon  intestinal  irritation,  emetics,  cathartics,  anthel- 
mintics, <kc,  will  be  required,  according  to  the  nature  of  the  cause  of 
the  intestinal  trouble.  If  general  debility  and  irritability  be  present, 
tonics  will  be  the  appropriate  remedies.  By  pursuing  this  course  of 
management,  viz.  by  removing  the  cause  of  the  disease  and  correcting 
the  existing  condition  of  the  system,  much  may,  in  general,  be  done  to 
eradicate  it.  "With  regard  to  the  use  of  antispasmodics,  the  result  of 
experience  has  demonstrated  that  little  reliance  can  be  placed  on  them. 


436  MATERIA   MEDIC  A    AND    THERAPEUTICS. 

The  only  one  that  has  had  much  reputation  is  Valerian.  Of  these  the 
older  writers  speak  in  the  highest  terms.  Tissot  says,  if  epilepsy  resist 
Valerian  it  must  be  incurable  !  ! 

Alibert,  on  the  other  hand,  says  that  he  tried  it  for  six  years  in  the 
Hospital  of  St.  Louis  and  always  without  success.  It  is  said,  however, 
that  he  used  the  infusion,  which  is  almost  inert.  Still  Valerian  is 
very  far  from  being  a  specific.  In  many  cases  it  may  prove  serviceable 
by  its  stimulant  operation  on  the  nervous  system,  while  in  others  it  is 
inefficacious.  In  young  subjects  where  the  disease  is  recent,  and  where 
it  is  not  connected  with  any  organic  difficulty,  this  remedy  may  be 
good.  In  using  it,  however,  special  regard  should  be  had  to  the  condi- 
tion of  the  system.  As  it  is  stimulating  in  its  action,  it  should  be  used 
with  great  caution  where  plethora  or  local  determination  exist.  To 
obtain  its  best  effect,  too,  it  should  be  used  in  full  doses. 

Chorea. — This  is  a  disease  in  which  we  might  suppose  the  agents 
commonly  called  antispasmodics  could  be  used  with  advantage,  and 
experience  has  proved  that  as  auxiliaries  they  may  frequently  be  very 
valuable.  As  general  remedies  calculated  to  control  spasms,  however, 
they  are  very  ineffectual.  Like  epilepsy,  chorea  arises  from  various 
causes  and  is  associated  with  different  states  of  the  system.  It  is  im- 
possible, therefore,  that  any  one  mode  of  treatment  or  any  particular 
set  of  remedies  can  answer  in  all  cases.  Under  different  circumstances, 
bloodletting,  purgatives,  tonics,  revulsives,  &c,  are  all  useful  remedies, 
and  so  are  antispasmodics.  In  cases  marked  by  fulness  of  habit  or  an 
inflammatory  diathesis,  they  are  always  improper.  On  the  other  hand 
where  this  is  not  the  case  and  where  the  temperament  is  highly 
nervous  and  excitable,  they  may  frequently  be  used  with  advantage  in 
conjunction  with  other  agents.  By  Copland,  after  the  preliminary 
exhibition  of  purgatives  and  the  use  of  suitable  depletion,  Valerian  is 
highly  recommended  in  connection  with  tonics.  Eberle  has  found 
assafcetida,  in  combination  with  quinine,  successful  after  due  evacuations. 
Pills  containing  one  gr.  of  sulphate  of  quinine  and  two  gr.  of  assafcetida 
were  given  every  four  hours.  In  chorea  coming  on  about  the  age  of 
puberty  in  females,  assafcetida  has  been  specially  recommended. 

Hysteria. — There  is  no  disease  in  which  the  power  of  antispas- 
modics is  more  strikingly  shown  than  in  this.  Even  here,  however, 
they  are  not  to  be  looked  upon  as  specifics.  Hysteria,  like  all  spasmo- 
dic affections,  depends  upon  various  conditions  of  the  system,  and  the 
treatment  must  be  directed  accordingly.  During  the  convulsion, 
according  to  the  state  of  the  patient,  bleeding,  emetics,  enemata,  &c, 
are  among  the  remedies  first  to  be  employed,  with  the  view  of  removing 
the  cause  which  may  produce  it.     Among  the  agents  proper,  after  this, 


NKHVINKS.  \->l 

to  act  specifically  on  the  nervous  system,  Bome  of  the  antispasmodics, 
in  combination  with  opium,  maybe  employed.  Of  these  ether  and 
assafcetida  are  among  the  best.  Ether  is  very  prompt  in  its  action,  and 
in  combination  with  laudanum,  is  efficient  in  controlling  Bpasm.  The 
tincture  of  assafcetida  and  laudanum  also  acts  very  well.  Where  it  a 
difficult  to  get  anything  into  the  Btomach,  the  same  may  be  accom- 
plished by  an  enema.  For  this  purpose,  from  a  scruple  to  half  a 
drachm  of  assafcetida  may  be  rubbed  up  with  half  a  pint  of  water, 
with  the  addition  of  a  drachm  of  laudanum,  and  this  injected  into  the 
rectum. 

In  chronic  hysteria,  independent  of  convulsion,  in  which  the  whole 
nervous  system  appears  to  be  in  a  deranged  condition,  some  of  the 
agents  of  this  class  are  the  remedies  resorted  to,  and  at  the  head  of  the 
list  is  assafcetida.  It  acts  with  more  power  and  efficiency  than  any  other 
agent.  Besides  stimulating  the  nerves,  assafcetida  is  useful  in  1 1 1 < ■-«.■ 
cases  by  proving  laxative.  In  some  cases,  sulphuric  ether  and  laudanum, 
in  doses  of  ten  drops  of  laudanum,  and  twenty  of  ether,  repeated  every 
two  hours,  answer  a  good  purpose.  Valerian,  too,  frequently  proves 
beneficial,  and  particularly  in  cases  where  a  tonic  to  the  digestive  organs 
is  required ;  the  tincture  is  the  best  preparation.  Castor,  too,  in  some 
cases  proves  salutary — so  does  the  skunk  cabbage.  .Dr.  Thacher  states 
that  in  a  case  of  violent  hysteria,  in  which  musk  and  other  antispasmo 
dies  had  failed,  two  teaspoonfuls  of  the  powdered  root  in  spirit  and 
water  afforded  immediate  relief.  Eberle  states  that  he  has  given  this 
frequently  in  chronic  hysteria,  and  with  advantage.  He  gave  a  wineglass 
of  the  injusion  (  3  i  of  the  root  to  a  pint  of  water)  every  four  or  five  hours. 

After  all,  however,  antispasmodics  are  mere  auxiliaries,  and  more  may 
be  done  in  the  intervals  b}7  tonics  and  other  remedies  calculated  to  cor- 
rect the  general  condition  of  the  system. 

Spasmodic  Asthma. — In  this  complaint  antispasmodics  have  been  ex- 
tensively used,  and  in  some  cases  with  benefit.  The  simple  inhalation 
of  the  vapor  of  ether  frequently  proves  exceedingly  beneficial ;  assafce- 
tida has  also  been  given  with  advantage.  Of  the  simple  antispasmodics, 
however,  the  skunk  cabbage  is  the  most  efficacious.  This  remedy  was 
first  recommended  by  the  Rev.  Dr.  Cutler,  by  whom  it  was  frequently 
found  successful  when  all  others  had  failed.  From  thirty  to  forty  grains 
of  the  dried  pulverized  root  were  given  every  two  or  three  hours  during 
the  paroxysm,  according  to  the  urgency  of  the  symptoms.  After  the 
paroxysm  has  subsided,  the  use  of  the  remedy  is  to  be  persevered  in  for 
some  days.  This  mode  of  treatment  is  said  to  have  been  obtained  from 
the  Indians,  who  repeat  the  dose  for  several  mornings  after  the  paroxysm 
has  passed  off.  By  others  this  remedy  has  been  tried,  and  with  bene- 
ficial results. 


438  MATERIA    MEDICA   AND   THERAPEUTICS. 

The  antispasmodic,  however,  which  answers  better  in  this  disease  than 
any  other,  is  the  lobelia  inflata.  This  has  already  been  noticed  under 
the  head  of  emetics.  As  there  stated,  it  combines  the  action  of  an 
emetic  and  antispasmodic.  I  have  used  this  at  the  New  York  Hospital 
with  success  in  a  case  in  which  all  other  remedies  failed. 

Colic. — This  is  a  disease  which  arises  from  various  causes,  and  is  con- 
nected with  varying  conditions  of  the  digestive  organs.  The  treatment 
must  of  course  vary  according  to  the  severity  of  the  case — bloodletting, 
evacuants,  warm  bath,  opium,  and  the  like,  are  the  remedies  to  be 
depended  upon.  As  to  antispasmodics,  they  can  only  be  useful  under 
certain  circumstances.  In  the  milder  forms  of  it,  and  where  it  arises 
merely  from  disordered  functions  and  flatulency,  they  are  frequently  of 
great  service.  In  this  way,  as  gentle  stimulants,  they  may  be  used  with 
advantage  in  gastrodynia  and  dyspepsia.  In  these  assafoetida  frequently 
proves  a  valuable  remedy. 

Where  anything  like  active  irritation  or  inflammation  is  present,  these 
ought  to  be  abstained  from. 

In  the  griping  to  which  children  are  subject,  connected  with  a  disor- 
dered state  of  the  bowels,  assafoetida  sometimes  proves  exceedingly 
beneficial. 


INDIVIDUAL    NERVINES. 


This  is  an  animal  product.  It  is  obtained  from  the  3foschus  moschi- 
ferus,  an  animal  inhabiting  the  mountains  of  Eastern  Asia,  and  dwelling 
on  the  highest  of  the  snowy  peaks.  It  resembles  the  deer  a  good  deal 
in  appearance,  and  is  seldom  longer  than  three  feet.  On  the  belly  of 
this  animal,  between  the  umbilicus  and  the  prepuce,  is  a  bag  covered 
with  hair,  of  an  oval  shape,  which  contains  the  musk.  It  is  about  three 
inches  long  and  two  broad,  and  is  found  only  in  the  males.  Internally 
it  is  lined  with  a  smooth  membrane  having  irregular  folds  in  it.  It  is 
this  membrane  which  is  supposed  to  secrete  the  musk.  In  the  young 
animal  there  is  no  musk  found ;  it  exists  only  in  the  adult.  The  quan- 
tity which  the  sac  contains  is  from  one  to  two  or  three  drachms.  By 
rubbing  against  the  rocks  the  animal  frequently  expresses  a  part  of  the 
musk,  and  this  is  said  to  be  the  purest  kind.  Generally,  however,  the 
musk  is  obtained  by  cutting  away  the  bag,  and  this  is  usually  done  while 
the  animal  is  still  alive.  A  small  hollow  reed  is  inserted  into  the  bag  for 
the  purpose  of  admitting  air,  and  it  is  then  suffered  to  dry.  It  is  in  this 
state  that  the  musk  is  imported  from  China. 


NERVINES.  439 

Physical  Properties. — Musk  in  the  living  animal  is  a  viscid  Becretion. 
When  dried,  it  is  converted  into  friable,  solid  grains.  They  are  unctu- 
ous to  the  touch  and  of  u  reddish-brown  color,  resembling  agood  deal 

dry  coagulated  blood.  Its  taste  is  bitter  and  disagreeable,  and  it-  odor 
is  powerful  and  peculiar — exceedingly  diffusible  and  permanent.  In 
combination  with  other  perfumes,  it  is  said  to  possess  the  property  <S 
increasing  their  odor  without  imparting  its  own. 

Varieties  of  Musk. — There  are  two  kinds  of  musk  brought  to  the 
market,  botb  coming  in  bags,  convex  and  hairy  on  one  side,  and  flat  and 
destitute  of  hair  on  the  other.  1.  The  Chinese  or  Tonrjuin  musk.  This 
comes  from  Tonquin,  and  is  brought  from  China.  The  sacs  are  smaller 
and  rounder  than  the  other  variety,  and  the  hair  which  covers  them  is 
of  a  red  color.  2.  The  Russian,  called  also  the  Kabardine  musk,  comes 
from  Siberia,  and  is  imported  through  Russia.  In  this  the  sacs  are 
larger  and  longer,  and  covered  with  a  coarse  white  hair. 

The  best  mode  of  purchasing  the  musk  is  in  the  bag. 

Chemical  Composition  and  Properties.  —  According  to  the  analysis  of 
Gnibourt  and  Blondeau,  musk  contains  the  following  constituents,  viz. 
water,  ammonia,  stearine,  elaine,  cholestcrine,  an  acid  oil  combined  with 
ammonia,  a  volatile  oil,  hydrochlorates  of  ammonia,  potash,  and  lime,  an 
undecided  acid,  partly  saturated  with  the  same  bases,  gelatine,  albumen, 
fibrine,  a  highly  carbonized  matter  soluble  in  water,  a  soluble  calcareous 
salt  with  a  combustible  acid,  carbonate  of  lime,  phosphate  of  lime,  hair 
and  sand. 

Musk  is  soluble  in  water ;  boiling  water  taking  up  about  80  parts  in 
100.  Alcohol  dissolves  about  50  parts  in  100.  Ether  takes  up  nearly 
the  whole. 

Effects  on  the  System. — When  taken  internally,  musk  produces  un- 
pleasant effects  on  the  stomach,  producing  eructations  with  sense  of 
weight,  dryness  of  the  fauces,  vertigo,  oppression  of  the  brain,  headache, 
followed  with  disposition  to  sleep.  Large  doses  induce  faintness,  vertigo, 
trembling  of  the  limbs,  pulse  more  frequent  and  fuller. 

Therapeutic  Effects. — Musk  being  an  excitant  to  the  nervous  svstem, 
is  proper  where  such  an  agent  is  desired.  It  is  used  in  low  fevers,  in 
spasmodic  affections  unaccompanied  with  cerebral  fulness. 

Dose. — From  10  to  20  grs.  either  in  bolus  or  emulsion.  The  tincture 
is  a  bad  form. 

VALERIAN. 

The  tree  which  yields  this  is  the  Valeriana  officinalis,  a  plant  indi- 
genous in  England  and  on  the  continent  of  Europe.  The  part  used  in 
medicine  is  the  root,  which  consists  of  slender  twisted  fibres,  coming  off 
from  a  tuberous  bead.     The  proper  period  for  digging  up  the  roots  is  in 


440  MATEEIA   MEDICA    AND   THERAPEUTICS. 

the  autumn  when  the  leaves  decay,  or  in  the  spring  before  the  flowers 
expand.  They  should  then  be  kept  in  a  dry  place.  The  best  comes 
from  England. 

Physical  Properties. — The  root  of  Valerian  is  of  a  yellowish-brown 
color  externally  and  white  internally.  When  fresh  it  has  scarcely  any 
smell,  but  on  drying  acquires  a  strong  foetid  odor.  Its  taste  is  first 
sweetish,  but  afterwards  bitter  and  aromatic. 

.Effects  and  Uses. — These  were  referred  to  when  speaking  of  antispas- 
modics generally.  As  a  stimulating  antispasmodic,  it  is  relied  on  by 
many  in  hysteria,  and  will  sometimes  remove  milder  forms  of  epilepsy. 
It  is  an  excellent  remedy  in  hemicrania  where  the  state  of  the  system 
will  admit  of  a  stimulant. 

Mode  of  Administration. — Valerian  is  used  in  powder,  infusion,  and 
tincture.  The  powder  is  apt  to  disagree  with  the  stomach — the  infu- 
sion is  of  uncertain  strength.     The  best  form  is  tincture.     The  ammoni- 


ated  tincture  is  a  very  valuable  antispasmodic. 


Dose. — Powder  3  i.     Tincture   §  ss.  (  "3 


! 


^iure   3  ss. \3/;>  1/^^^ 


ASSAFCETIDA. 

The  plant  which  yields  this  drug  is  the  narthex  assafcetida.  It  grows 
native  in  the  south  of  Persia,  with  a  stem  about  nine  feet  high  and  seven 
or  eight  inches  in  circumference  at  the  base.  The  root  is  perennial,  and 
when  fully  grown  is  as  large  as  a  man's  leg.  It  contains  a  large  quan- 
tity of  a  foetid  milky  juice,  wdiich  is  the  substance  used  in  medicine. 
The  mode  of  obtaining  it  is  the  following  :  When  the  root  is  four  years 
old  (until  which  time  it  is  not  fit  to  yield  it),  at  the  season  when  the 
stem  begins  to  wither,  this  is  torn  off  from  the  root,  which  is  then  ex- 
posed by  digging  away  the  earth  that  surrounds  it.  In  this  state  it  is 
left  screened  from  the  sun  for  forty  days.  The  top  of  the  root  is  then 
cut  off  transversely,  and  after  forty-eight  hours  the  juice  which  has  exuded 
is  scraped  off.  Another  slice  is  then  cut  off,  and  this  operation  is  re- 
peated until  all  the  juice  is  exhausted,  when  the  root  dies.  This  process 
occupies  about  six  weeks,  and  during  this  time  the  root  is  protected 
from  the  sun's  rays.  The  juice  thus  collected  is  then  put  together  and 
dried,  and  this  is  the  assafcetida  used  in  medicine.  It  comes  to  this 
oountry  either  from  India  or  by  the  way  of  Great  Britain  in  bags  or 
cases  containing  from  one  to  two  hundred  or  more  pounds. 

Physical  Properties. — Assafcetida,  as  imported,  is  in  large  irregular 
masses  adhering  together,  externally  of  a  brownish  yellow  color,  and 
interspersed  with  tears  of  a  white,  red,  or  violet  blue.     When  broken  it 
presents  a  variegated,  shining  surface  of  a  whitish  color,  which,  on  expo 
sure,  changes  to  a  reddish  brown.     Sometimes,  but  rarely,  the  assafce- 


NERVINES.  1  1  I 

tida  cornea  in  separate  tears.  The  odor  is  foetid  and  resemblee  thai  of 
garlic,  and  its  taste  is  sharp,  acrid,  and  bitter.  The  besl  kind  i-  thai 
w  1 1 i < ■  1 1  is  clcai-  in  its  appearance,  of  a  pale  reddish  color,  and  contain  a 
greal  number  of  the  whitish  tears,  and  has  the  peculiar  odoi  ong. 

On  long  keeping  and  exposure  to  the  air,  it  becomes  bard  and  brittle, 
and  at  the  same  time  loses  much  of  its  odor  and  somewhat  of  it-  I  i 
Even  when  dry,  assafu-tida  is  pulverized   with  difficulty. 

Chemical  Composition  and  Properties. — According  to  the  analj  is  of 
Pelletier,  assafoetida  contains  in  LOO  parts,  resin,  65  ;  gnm,  19.44  ;  baf 
rine,  11.66;  volatile  oil,  3.60  ;  supermalate  of  lime,  0.30. — (Guibourt.) 
It  belongs,  therefore,  to  the  class  of  gum  resins.  It  is  soluble  in  alcohol, 
forming  a  clear  solution,  which  becomes  milky  on  the  addition  of  water. 
Triturated  with  water  it  forms  a  milky  opaque  mixture,  from  which  the 
resin  is  gradually  deposited,  unless  yolk  of  egg  or  mucilage  be  added. 

Effects  and  Use. — This  is  one  of  the  most  valuable  and  most  reliable 
of  the  antispasmodics,  and  from  its  action  on  the  bowels  will  often  pro- 
duce the  best  effects  in  hysteria  and  other  kindred  affections.  Its  ^ 
effects  on  the  bronchial  secretion  have  already  been  noted.  (Sec  Ex- 
pectorants.) It  also  stimulates  the  uterus,  and  perhaps  the  whole 
genital  apparatus,  in  the  male  as  well  as  the  female. 

Skunk  Cabbage. — This  is  known  by  various  names,  such  as  the  Dra- 
contium  fcetidum,  Ictodes  jaitidus,  Synvplocarpus  fcetidus.  This  singular 
plant  is  indigenous  in  this  country,  and  is  found  growing  in  wet  woods, 
swamps,  and  on  the  margins  of  brooks  and  rivulets.  It  flowers  about 
the  end  of  April  or  the  beginning  of  May.  The  root  is  the  part  used  in 
medicine.  The  proper  period  for  collecting  it  is  early  in  the  spring  or 
in  the  autumn.     It  should  be  carefully  dried  for  use. 

Physical  Properties. — The  root  of  this  plant  consists  of  a  thick  body, 
with  numerous  radicles.  The  body  is  two  or  three  inches  long  and  one 
inch  thick.  The  radicles  are  about  the  thickness  of  a  common  quill. 
Externally  the  root  is  covered  with  a  brownish  epidermis;  internally  it 
is  white  and  amylaceous.  When  fresh  it  has  a  peculiarly  foetid  odor. 
This  is  supposed  to  depend  upon  the  presence  of  a  volatile  oil  which  is 
dissipated  by  heat  and  exposure.  Its  taste  is  acrid,  but  it  loses  this  by 
long  keeping.  As  the  virtues  of  this  article  depend  upon  its  sensible 
properties,  it  is  evident  that  they  become  impaired  by  keeping.  The 
recently  dried  root  should  therefore  always  be  preferred. 

Chemical  Properties. — "It  seems  to  contain  a  volatile  acrid  principle, 
readily  dissipated  by  heat ;  a  resinous  substance,  and  a  gummy  or  muci- 
laginous principle.  The  seeds  contain  a  considerable  quantity  of  fixed 
oil." — Edwards's  Manual,  p.  308. 

Effects. — This  article,  if  given  in  moderate  doses,  proves  stimulant 
and  antispasmodic.     In  large  doses  it  causes  nausea  and  vomiting,  and 


442  MATERIA   MEDICA   AND   THERAPEUTICS. 

powerfully  affects  the  nervous  system,  producing  sometimes  headache, 
vertigo,  and  impaired  vision.  It  was  originally  introduced  into  practice, 
by  the  Rev.  Dr.  Cutler,  by  whom  it  was  highly  recommended  in  asthma. 
It  has  been  used  with  occasional  success  in  hysteria,  chronic  catarrh, 
pertussis,  and  chronic  rheumatism. 

Mode  of  Administration. — The  best  form  is  that  of  powder  in  doses  of 
from  10  to  20  or  30  grains.  As  the  volatile  oil  is  more  apt  to  be  dis- 
sipated when  in  powder,  it  should  never  be  pulverized  until  required 
for  use. 

CAJUPUT    OIL. 

This  oil  was  formerly  supposed  to  be  the  product  of  the  Melaleuca 
leucodendron.  The  tree  which  yields  it  is  now,  however,  found  to  be  a 
different  species,  and  is  called  the  Melaleuca  cajuputi,  a  small  and 
beautiful  tree,  growing  native  in  the  Molucca  Islands.  The  oil  is  con- 
tained in  the  leaves,  and  is  obtained  from  them  by  distillation.  From 
the  small  quantity  which  the  leaves  contain,  the  oil  bears  a  high  price. 
It  is  brought  from  the  East  Indies  in  glass  bottles. 

Properties. — This  oil  is  of  a  beautiful  greenish  color,  transparent,  and 
very  fluid  ;  its  taste  is  pungent  and  aromatic,  and  its  odor  is  penetrat- 
ing, and  resembles  that  of  a  mixture  of  camphor  and  turpentine.  It  is 
lighter  than  water,  exceedingly  volatile,  and  burns  without  leaving  any 
residue.  When  dropped  in  water,  it  diffuses  itself  over  the  surface  and 
rapidly  evaporates.     In  alcohol  it  dissolves  very  readily. 

Adulterations. — From  the  high  price  of  this  article,  every  temptation 
is  held  out  for  its  adulteration,  and  this  accordingly  is  frequently  done. 
The  articles  principally  used  for  this  purpose  are  the  oil  of  turpentine, 
the  oil  of  rosemary,  camphor,  &c.  Its  purity  is  ascertained  by  some  of 
its  properties  already  mentioned. 

1.  Drop  some  of  it  on  the  surface  of  water,  and  if  it  be  pure  it  will 
diffuse  itself  rapidly  over  it,  and  evaporate  completely. 

2.  It  burns  rapidly  when  ignited  without  any  residue. — 3.  It  dissolves 
entirely  in  alcohol,  which  is  not  the  case  when  sophisticated  with  tur- 
pentine. 

Effects. — When  taken  internally,  cajuput  oil  acts  as  a  local  and 
general  excitant.  It  produces  a  sense  of  warmth  in  the  stomach,  and 
speedily  extends  its  influence  to  the  rest  of  the  system  ;  the  pulse  is 
increased  in  force  and  frequency,  blood  determined  to  the  surface,  and 
perspiration  induced.  Its  use,  therefore,  is  principally  in  those  cases  in 
which  it  is  desirable  by  means  of  an  excitant  to  equalize  the  circulation, 
and  to  determine  to  the  sjorface. 

Dose. — The  dose  is  from  two  to  six  drops  well  rubbed  up  with  sugar. 
Applied  externally,  it  forms  a  good  stimulating  embrocation  in  cases  of 
rheumatism — one  part  of  cajuput  oil  diluted  with  four  parts  of  olive  oil. 


NKHVINK8.  Ufl 


BTRYOIINOS    NUX    VOMICA. 

This  is  tho  Vomica  Nut.  Tt  is  obtained  from  a  tree  growing  in  various 
parts  of  the  East  Indies.    Tt  is  of  a  middling  size,  with  a  crooked  and 

thick  trunk.  This  tree  yields  a  round  fruit  about  the  size  of  an  ora 
covered  with  a  smooth,  hard  rind  of  a  beautiful  golden  yellow  color,  and 
filled  with  a  soft,  jelly-like  bitter  pulp.  In  this  pulp  are  imbedded  a 
number  of  seeds,  generally  from  three  to  five.  These  are  the  vomica  nuts 
of  medicine  and  commerce.  They  are  round  and  flat,  with  a  depression 
in  the  centre,  resembling  somewhat  in  shape  the  button  of  a  coat.  They 
are  from  half  an  inch  to  three  quarters  of  an  inch  in  diameter,  and  about 
a  quarter  of  an  inch  in  thickness,  of  a  yellowish  grey  color  when  good 
(when  inferior  they  are  black)  ;  their  taste  is  bitter  and  acrid,  but  they 
have  no  smell. 

Chemical  Properties. — Besides  several  other  less  important  ingre- 
dients, the  vomica  nut  has  been  ascertained  to  contain  the  three  follow, 
ing  principles,  upon  which  its  active  properties  are  supposed  entirely  to 
depend. 

1.  Strychnine,  a  peculiar  alkaline  principle. 

2.  Brucine,  another  alkaline  principle. 

3.  Igasuric  acid,  so  called  from  the  Malay  name  of  the  bean  of  St. 
Ignatius.  This  acid,  since  named  Strychnic,  exists  in  combination  with 
both  of  the  alkaline  substances  just  mentioned,  forming  Igasurates  or 
Strych  nates. 

Effects  on  the  System. — The  effects  of  this  article  on  the  system  are 
decided  and  peculiar.  According  to  the  experiments  of  Magendie,  it 
appears  to  be  established  that  the  nux  vomica  possesses  the  singular  pro- 
perty of  exciting  the  spinal  marroio  and  the  nerves  issuing  from  it,  as  well 
as  the  muscles  supplied  by  the  nerves,  without  at  the  same  time  affecting 
the  functions  of  the  brain,  except  indirectly.  Hence,  wheu  given  in  suita- 
ble quantities,  it  produces  spasms  of  the  muscular  system  precisely  simi- 
lar to  those  of  tetanus,  the  muscles  becoming  sometimes  rigidly  fixed, 
while  at  others  there  are  violent  states  of  spasm  alternating  with  fits  of 
relaxation.  On  the  digestive  organs  it  acts  as  a  tonic,  and  accordingly  it 
will  be  found  that  during  its  use  in  moderate  doses,  the  appetite  is  gene- 
rally improved,  at  the  same  time  the  evacuations  from  the  bowels  are 
rendered  less  frequent.  "  In  general,  the  superior  extremities  are  bent, 
and  the  inferior  ones  extended.  The  intellectual  faculties  are  not  dis- 
turbed, but  there  is  sometimes  present  a  sort  of  intoxication.  Sometimes 
the  urinary  and  genital  organs  are  irritated.  When  the  dose  is  a  little 
too  large,  there  comes  on  difficulty  of  respiration,  swallowing,  speaking, 
and  urinating,  general  agitation  and  sweat,  but  all  this  is  ordinarily  un- 
attended with  danger." — Bayle,  vol.  ii.  p.  241. 

29 


444  MATERIA   MEDICA  AND  THERAPEUTICS. 

These,  then,  may  be  considered  as  the  effects  of  this  agent  on  the  sys- 
tem when  used  in  suitable  doses,  viz. — a  tonic  to  the  digestive  organs, 
and   an  excitant  to  the  spinal  marrow  and  its  dependent  nerves  and   | 
muscles.     To  produce  these  effects,  it  is  requisite  to  give  it  in  suitable 
doses,  and  continue  it  for  a  certain  length  of  time. 

Modifying  Circumstances. — 1.  Dose. — This  modifies  very  greatly  the 
effect  of  this  agent.  When  given  in  very  small  quantities,  no  sensible 
effect  follows.  When  given  in  moderate  medicinal  doses,  it  produces 
twitching,  pricking,  and  slight  spasms  of  the  limbs ;  if  the  quantity  be 
still  further  increased,  decided  tetanic  spasms  are  brought  on,  propor- 
tioned to  the  quantity  taken,  and  the  length  of  time  its  use  may  have 
been  continued.  Finally,  if  it  be  given  in  still  larger  doses,  it  acts  as  a 
decided  poison.  For  the  purpose  of  ascertaining  the  mode  in  which 
death  takes  place,  numerous  experiments  have  been  made  upon  animals. 
"  Half  a  drachm  of  the  powder  killed  a  dog  in  forty-five  minutes,  and  a 
grain  and  a  half  of  the  alcoholic  extract  thrust  into  a  wound  killed 
another  in  seven  minutes.  The  animals  uniformly  experienced  dreadful 
fits  of  tetanic  spasm,  and  died  during  a  paroxysm.  The  cause  of  death 
appears  to  be  prolonged  spasm  of  the  muscles  of  respiration.  The  spasm 
of  these  muscles  is  apparent  in  the  unavailing  efforts  which  the  animals 
make  to  inspire.  The  external  muscles  of  the  chest  may  be  felt  during 
the  fits  as  hard  almost  as  a  bone,  and  according  to  an  experiment  of 
Wepfer,  the  diaphragm  partakes  in  the  spasm  of  the  external  muscles." 
According  to  Fouquier  the  diaphragm  is  ordinarily  feebly  and  slowly 
affected  by  this  agent.  Hence  it  is  that  in  the  medicinal  use  of  it,  the 
general  tetanus  which  occurs  is  attended  with  little  danger.  According 
to  the  experiments  of  Magendie,  the  division  of  the  -spinal  marrow  and 
even  complete  decollation  do  not  interfere  with  the  peculiar  action  of 
this  substance. 

On  the  human  subject  the  effects  are  the  same  as  those  in  animals, 
and  the  mode  of  death  is  analogous. 

"With  regard  to  the  dose  requisite  to  prove  fatal,  the  smallest  fatal 
dose  of  the  alcoholic  extract  yet  recorded  is  three  grains."  "  Hoffmau 
mentions  a  fatal  case  caused  by  two  fifteen  grain  doses  of  the  powder ; 
and  in  Hufeland's  Journal  there  is  another  caused  by  two  drachms, 
which  was  fatal  in  two  hours." 

2.  The  Actual  Condition  of  the  System  as  to  Disease^ — The  action  of 
this  substance  on  the  spinal  marrow  and  the  muscles  is  the  same  in  a 
state  of  health  as  in  disease,  with  this  very  striking  difference,  which 
was  first  observed  by  Fouquier,  and  afterwards  confirmed  by  others.  In 
cases  of  paralysis,  the  first  effects  of  the  remedy  are  felt  in  the  paralyzed 
limb.  In  most  cases,  when  spasmodic  contractions  begin  in  the  para- 
lyzed parts,  they  do  not  -extend  beyond  this,  unless  the  dose  be  consider- 
ably increased. 


NERVINES.  445 

Mode  of  Adiiihiiii ration. —  1.  Powder. — In  this  form   il    is  seldom 
given,  being  uncertain  in  its  effects.     It,  may  1":  given  in  closes  of  from 
four  arrive  grains,  repeated  three  or  four  times  a  day,   until   it     eff 
are  felt. 

3.  Alcoholic  Extract— This  is  a  preferable  form  to  the  powder,  -till 
somewhat  uncertain  from  the  variable  strength  of  the  article.  I 
may  be  taken  in  pill  in  closes  from  half  a  grain  to  two  grains,  to  be 
repeated  three  times  a  day.  This  quantity  per  diem  may  be  increased 
gradually  until  the  desired  effect  is  produced.  "  Tn  general,  from  lour 
to  six  grains  a  day  will  be  sufficient  to  produce  tetanic  action  ;  but 
sometimes  it  has  required  as  much  as  twenty-four  or  thirty  grains  in 
the  day."  It  is  important  to  recollect,  that  if  the  use  of  the  medicine 
is  discontinued,  on  its  being  recommenced  the  smallest  doses  must  be 
given,  and  then  gradually  increased. 

4.  Tincture. — Ext.  nucis  vom.  grs.  iij. ;  alcohol,  ?  i.  M.  Of  this 
from  t\vejvty__to  thirty  drops  may  be  taken  at  a  time.  This  is  also  a 
good  friction  to  the  paralysed  part. 

Strychnine. — This  alkali  was  discovered  in  1818  by  Pelletier,  who 
found  it  in  the  Strycknos  nux  vomica,  and  from  hence  it  derives  its 
name.  Since  then  it  has  been  found  in  the  Strycknos  ignatia,  the 
Strycknos  colubrena,  and  in  the  Upas  tiente  of  Java.  It  exists  asso- 
ciated with  another  vegetable  alkali,  brucine,  and  both  are  in  combina- 
tion with  strychnic  acid,  formerly  called  the  igasuric  acid. 

It  is  obtained  by  boiling  the  bruised  nux  vomica  in  spirit  three  times 
successively,  and  pouring  off  and  straining  the  several  liquors.  Distil 
off  the  spirit,  and  evaporate  what  remains  to  the  consistence  of  an 
extract. 

Here  the  alcoholic  extract  contains  Strychnate  of  strycknine,  with 
some  admixture.  This  is  now  to  be  dissolved  in  cold  water  and  strained. 
The  water  dissolves  out  the  strychnate  of  strychnine,  and  separates 
some  fatty  matter  united  with  it.  This  is  then  to  be  evaporated  with  a 
gentle  heat  to  the  consistency  of  a  syrup,  and  while  warm  mao-nesia  is 
added  to  saturation.  After  standing  for  two  days,  the  supernatant 
liquor  is  poured  off.  The  magnesia  decomposes  the  strychnate,  forming 
strychnate  of  magnesia,  which  is  held  in  solution,  while  the  strychnine 
is  precipitated. 

The  precipitate  is  then  to  be  boiled  in  spirit,  strained,  and  distilled. 
To  this  add  sulphuric  acid  mixed  with  water,  and  afterwards  solution  of 
ammonia.  Here  a  sulphate  of  strychnine  is  formed,  which  is  again 
decomposed  by  ammonia,  and  the  strychnine  precipitated.  This  is 
then  again  dissolved  in  boiling  spirit  and  set  aside,  that  pure  crystals 
may  be  formed. 

Pi-operties. — When  pure,  strychnine  is  a  white  crystalline  substance  ; 


446  MATERIA    MEDICA   AND    THERAPEUTICS. 

when  obtained  by  spontaneous  evaporation,  it  is  in  minute  crystals ;  but 
■when  rapidly  evaporated,  it  is  in  a  granular  form.  It  is  without  smell, 
but  lias  an  intensely  bitter  taste.  The  bitter  is  so  intense  that  it  im- 
parts its  taste  to  600,000  times  its  weight  of  water.  It  requires  about 
6,600  times  its  weight  of  cold,  and  2,500  times  its  weight  of  boiling 
water,  to  dissolve  it.  In  boiling  alcohol  it  is  soluble,  but  scarcely  at  all 
in  cold. 

Strychnine  acts  like  the  alkalies  on  vegetable  colors,  neutralizes  acids, 
and  forms  crystallizable  salts.^  It  is  unaffected  by  the  atmosphere.  It 
is  neither  volatile  nor  fusible,-  being  melted  by  heat  only  at  the  moment 
of  decomposition,  which  takes  place,  however,  at  a  comparatively  low 
temperature. 

Purity. — As  this  article  is  very  expensive,  the  temptation  to  sophis- 
tication is  strong ;  as  the  quantity  which  is  used  at  a  dose  is  small,  it  is 
of  course  very  important  to  have  it  pure,  otherwise  constant  disappoint- 
ment must  occur  during  its  use. 

The  articles  with  which  it  is  most  commonly  sophisticated  are,  mag- 
nesia and  phosphate  of  lime.  To  ascertain  the  presence  of  these  the 
following  tests  will  answer  i 

1.  Dissolve  in  boiling  alcohoh     If  pure  it  will  be  entirely  soluble. 

2.  Subject  to  a  calcining  heat,  with  the  access  of  air.  If  pure  it  will 
be  entirely  decomposed  and  dissipated. 

In  its  ordinary  form  it  is  frequently  associated  with  hrucine.  This  is 
ascertained  thus  : 

1.  Moisten  the  suspected  strychnine  with  nitric  acid ;  if  it  assume  a 
blood-red  color,  it  contains  brucine^  if  not  it  is  pure. 

2.  Mix  a  solution  of  the  strychnine  with  a  solution  of  chloride  of  tin; 
if  it  produce  a  brown  precipitate,  it  contains  brucine,  if  not  it  is  pure. 

Effects  on  the  System. — These  are  the  same  as  the  nux  vomica,  only 
more  energetic.  When  given  in  sufficient  quantities  it  is,  next  to  the 
hydrocyanic  acid,  the  most  rapid  and  potent  poison  we  know  of.  Its 
terrible  effects  have  been  illustrated  by  numerous  experiments  upon 
animals.  Dr.  Christison  killed  a  dog  in  two  minutes  with  the  sixth 
part  of  a  grain,  injected  in  the  form  of  alcoholic  solution  into  the  chest. 
A  wild  boar  was  killed  in  the  same  manner  with  the  third  of  a  grain  in 
ten  minutes.  Dr.  C.  thinks  there  is  little  doubt  that  half  a  grain  thrust 
into  a  wound  might  kill  a  man  in  less  than  a  quarter  of  an  hour 

Modes  of  Administration. — The  ordinary  and  best  mode  of  using  it 
is  the  form  of  pill  made  with  the  conserve  of  roses.  The  best  way  is  to 
begin  with  the  y1^  or  the  T'g  of  a  grain,  repeated  three  times  a  day  and 
increased  until,  the  characteristic  effects  of  the  article  are  produced. 
With  respect  to  giving  strychnine  in  the  form  of  alkali,  it  is  well 
enough  to  recollect  that  the  activity  of  it  depends  upon  the  degree  of 
acid  in  the  stomach.    To  obviate  the  variable  effect  which  might  thus 


NERVINES.  117 

be  occasioned,  J)r.  Thomson  recommends  that  it  Bhould  be  given  in  the 
form  of  acetate.  This  he  directs  to  be  prepared  by  dissolving  gr.  j  of 
pure  strychnine  in  3j  of  distilled  vinegar,     Six  minims  of  this  contain 

one-tenth  of  a  grain,  wliicli    is  a  good  dose  to   begin    with.     Thi    maj 
be  gradually  increased. 

Tincture. — This  form  is  recommended  by  Magendie; 
Strychnine,  grs.  iij. 
Alcohol,    3  j. 
M. 
Dose,  6  to  24  drops. 

Salts  of  Strychnine. — Of  these  there  are  several.  The  only  one 
used  by  Magendie  is  the  sulphate.  This  acts  in  the  same  way  as  the 
strychnine,  only  more  active.     One  twelfth  of  a  gr.  is  a  dose.. 


APPLICATIONS    OF    NITX    VOMICA    AND    ITS    ALKALIES    IN    THE    TREATMENT 

OF    DISEASES. 

Serapion  appears  to  have  been  the  first  physician  by  whom  the  Xux 
Vomica  was  used  as  a  medicine.  The  Arabians  gave  it  as  an  antidote 
against  the  bites  of  serpents.  Between  the  sixteenth  and  eighteenth  cen- 
tury, physicians  resorted  to  it  occasionally  as  a  remedy  for  the  plague, 
for  tenia,  hydrophobia,  dysentery,  and  various  nervous  affections.  It  was 
not,  however,  until  within  a  few  j^ears  that  any  great  use  was  made  of  it 
as  a  remedial  agent.  In  IS  11,  Dr.  Fouquier,  reflecting  the  fact  esta- 
blished by  Magendie,  in  relation  to  the  peculiar  action  of  the  Nux  Vo- 
mica in  producing  tetanic  spasm  of  the  muscles  dependent  on  the  spinal 
marrow,  thought  it  might  be  applied  with  advantage  in  cases  of  paralysis. 
He  accordingly  tried  it  in  a  large  number  of  cases,  and  found  it  to  be  a 
most  valuable  remedy,  proving  in  many  cases  a  perfect  cure.  Since  the 
discovery  of  the  strychnine  this  has  been  still  further  tested,  and  its  effi- 
cacy in  many  cases  fully  established.  Like  all  other  remedies,  it  is  by 
no  means  infallible.  In  some  cases  it  does  no  good,  while  in  others  it 
causes  effects  which  no  other  is  capable  of  producing.  Everything  de- 
pends upon  the  nature  of  the  case.  Whenever  paralysis  is  the  result  of 
some  organic  derangement  of  the  brain,  such  as  tumors  pressing  upon 
the  substance  of  that  organ,  diseased  alterations  in  its  structure,  or  extra- 
vasations of  fluid  which  cannot  be  absorbed,  then  this  remedy  will  be  of 
no  avail.  On  the  other  hand,  where  the  paralysis  depends  upon  simply 
diminished  nervous  excitement,  it  has  been  completely  cured  by  the  use 
of  this  article.  Dr.  Thomson  says  he  considers  "strychnine  or  the  ext. 
of  nux  vomica  most  useful  in  those  cases  of  palsy  that  proceed  from  seda- 
tive impressions  on  the  intestinal  nerves,  such,  for  example,  as  occur 


448  MATERIA   MEDICA   AND  THERAPEUTICS. 

"when  carbonate  of  lead  taken  into  the  stomach  produces  colica  pic- 
tonum ;  and  indeed  in  every  case  of  palsy  of  the  motor  nerves  only, 
which  is  readily  known  by  the  sensibility  of  the  paralytic  limb  remain- 
ing after  the  power  of  motion  is  lost,  and  by  the  entire  state  of  the  sen- 
sorium  commune." — Vol.  i.  p.  255.  In  paraplegia  it  has  generally  been 
found  more  successful  than  in  hemiplegia.  The  first  effects  of  the 
remedy  in  all  cases  are  convulsive  twitchings  of  the  paralysed  parts,  and 
no  benefit  is  derived  from  its  use  until  this  effect  is  produced  and  conti- 
nued for  some  time.  If  plethora  should  be  present,  this  is  to  be  corrected 
by  venesection,  purgatives,  and  other  appropriate  treatment.  It  is  a 
great  advantage  attending  the  use  of  this  powerful  agent  (strychnine) 
that  it  does  not  at  all  impair  the  tone  of  the  stomach  'T  on  the  contrary, 
it  has  a  tendency  to-  increase  the  appetite  and  promote  digestion.  In 
having  recourse  to  the  strychnine,  the  best  way  is  to  commence  with  small 
doses,  increasing  them  gradually,  according  to  the  effect  produced.  One 
eighth  of  a  grain  twice  a  day  is  sufficient  to  begin  with.  This  may  be 
cautiously  increased  to  one  sixth,  one  quarter,  or  even  half  of  a  gr.  twice 
a  day.  Should  any  unpleasant  symptoms  occur,  of  course  its  use  should 
be  discontinued,  and  when  the  symptoms  subside  it  may  again  be  re- 
sumed. By  observing  these  general  precautions.,  there  is  no  danger  in 
using  this  otherwise  potent  agent. 

Besides  paralysis,  strychnine  has  also  been  used  with  success  in  chro- 
nic diarrhcea.  This,  as  you  probably  know,  is  a  very  serious  disease, 
and  sometimes  incurable  by  any  means  that  we  yet  are  acquainted 
with.  In  some  cases  which  had  obstinately  resisted  all  other  treatment, 
this  remedy  effected  a  cure.  Whenever  any  inflammatory  condition  of 
the  mucous  membrane  of  the  intestines  is  present  it  is  not  to  be  used. 
When  this  is  not  present,  and  especially  when  the  disease  occurs  in  fee- 
ble constitutions  and  in  old  people,  this  remedy  is  exceedingly  advan- 
tageous. Besides  the  effect  which  it  produces  on  the  intestines,  it  acts 
as  a  tonic  to  the  stomach,  and  in  this  way,  no  doubt,  aids  very  materially 
in  effecting  the  desired  relief.  One  twelfth  of  a  grain  two  or  three  times 
a  day  is  sufficient.  In  recommending  this  article,  I  would  not  advise 
you  to  fly  to  it  at  once  before  trying  other  means.  Your  best  plan  is  to 
reserve  it  till  everything  else  has  failed. 

In  certain  cases  of  amenorrhoea,  depending  upon  diminished  action  in 
the  uterine  vessels  and  the  system,  this  remedy  has  also  been  used  with 
considerable  success.  It  stimulates  the  vessels  of  the  uterus,  and  im- 
proves the  general  tone  and  vigor  of  the  system,  A  very  good  plan  in 
these  cases  is  to  combine  its  use  with  purgatives,  especially  when  there 
is  a  tendency  to  costiveness,  as  there  frequently  is. 

Brucine. — This  was  discovered  in  1818  by  Pelletier,  and  by  Caven- 
ton  in  1819,  in  the  inner  bark  of  the  brucia  antidjsenterica.     It  there 


Nicnvi  n  E8,  4 1 9 

exists  combined  with  the  gallic  acid,  in  the  state  of  a  gallate.  Since 
then  it  lias  been  found  united  with  strychnine  in  the  una  vomica  and  St. 
[gnatius  bean.    Brucine  is  a  crystalline  Bubstance  of  a  white  color,  d< 

tutc  of  smell,  but  intensely  bitter.  In  water  it  is  more  soluble  thai! 
most  other  vegetable  alkalies,  requiring  only  850  times  its  weight  of 
cold  and  500  of  boiling  water  for  its  solution.  In  alcohol  both  cold  and 
hot  it  is  very  soluble.  Tested  with  nitric  acid,  it  produces  a  blood-red 
color.  [This  blood-red  color  changes  to  yellow  by  heat.  This  is  the 
test  of  brucine,  and  if  it  happen  with  strychnine,  shows  the  presence  of 
brucine.  It  is  permanent  in  the  air,  but  melts  at  a  temperature  a  little 
above  212°.     On  cooling  it  forms  a  mass  resembling  wax.] 

Effects  on  the  System. — These  are  the  same  as  the  strychnine,  only  it 
is  less  active.  It  is  considered  to  be  about  ~  only  as  active  as  the 
strychnine. 

Modes  of  Administration. — JPill,  of  \  to  £  gr.,  to  be  increased  gradu- 
ally. 

Creasote. — This  is  a  peculiar  substance  discovered  by  Reichenbaeh. 
It  is  obtained  from  tar  and  pyroligneous  acid. 

It  is  a  colorless,  transparent  liquid,  of  an  oleaginous  consistence.  It 
has  a  disagreeable  penetrating  odor,  resembling  that  of  smoked  beef, 
with  a  burning  caustic  taste.  Its  specific  gravity  is  1.037,  boils  at  397° 
Far.,  and  is  not  congealed  at  the  temperature  of — 16.0°  Far.  It 
burns  with  a  smoky  flame,  combines  readily  with  acetic  acid,  water, 
alcohol,  ether,  and  the  alkalies.  It  coagulates  albumen.  Fresh  meat 
placed  for  an  hour  in  a  solution  of  creasote  and  well  dried,  may  be 
exposed  to  the  heat  of  the  sun  without  putrifying.  In  eight  days  it 
becomes  hard  and  smells  like  good  smoked  meat. 

Effects  on  the  System. — Applied  to  the  tongue  pure  creasote  produces 
severe  pain.  The  tongue,  however,  is  neither  red  nor  tumefied,  but  con- 
tracted. Along  with  this  there  is  a  smoky  taste  in  the  mouth.  Applied 
to  the  skin  it  produces  a  feeling  like  that  of  a  burn — causes  rubefaction, 
and  destroys  the  epidermis,  which  splits  and  falls  off  in  little  rough 
scales.  From  experiments  made  upon  animals,  it  appears  that  creasote 
acts  as  an  irritant  to  the  surfaces  with  which  it  comes  in  contact, 
whether  this  be  the  skin  or  the  mucous  membrance.  In  its  pure  state, 
if  taken  internally,  it  proves  poisonous  and  destroys  life.  As  a  medicine 
it  can  of  course  be  used  only  in  the  state  of  dilution. 

As  a  remedial  agent  creasote  has  been  used  principally  as  an  external 
application,  although  in  some  cases  it  has  been  given  internally. 

As  an  external  application,  creasote  has  been  much  commended  in 
burns,  especially  those  which  are  attended  with  excessive  suppuration 
or  fungous  granulations.  It  is  also  used  in  chilblains.  As  a  styptic  it 
will  often  control  a  mere  oozing  of  blood,  but  over  hemorrhage  from 


450  MATERIA   MEDICA   AND   THERAPEUTICS. 

vessels  of  any  size  it  has  no  power.  It  has  been  used  in  indolent  flabby 
ulcers,  in  scrofulous  and  venereal  ulcers,  and  even  in  cancer.  In  all  these 
cases  it  should  be  watched,  and  if  it  irritate,  should  be  suspended. 
Creasote  is  often  put  into  carious  teeth,  and  sometimes  checks  the  pain. 
In  some  of  the  scaly  eruptions  it  has,  when  properly  diluted,  the  best 
effects. 

Internally,  it  has  been  used  in  a  number  of  cases. 

1.  Phthisis  JPulmonalis. — In  this  disease,  creasote  has  been  recom- 
mended as  aiding  expectoration  and  also  cicatrization  of  ulcerations. 
By  Dr.  Elliotson  of  London  it  was  tried,  but,  as  he  says,  without  any 
good  effect,  when  given  internally.  When  used  in  the  way  of  inhala- 
tion, however,  he  reports  favorably  of  its  effects.  His  mode  of  using  it 
was  to  put  one  drop  of  creasote  into  rather  less  than  a  pint  of  cold 
water,  and  add  one  drop  every  time  it  is  employed  in  order  to  maintain 
the  strength  of  the  liquid.  Through  this  water  the  patients  were  made 
to  breathe  for  four  or  five  minutes  four  or  five  times  a  day.  In  those 
cases  in  which  the  ulceration  is  confined  to  the  mucous  membrane,  and 
in  cases  of  simple  bronchitis,  Dr.  Elliotson  thinks  it  has  been  of  decided 
benefit.     Also  in  asthma. 

2.  Vomiting. — As  an  agent  for  arresting  this  troublesome  affection, 
Dr.  Elliotson  thinks  that  the  efficacy  of  the  creasote  is  fully  established. 
From  the  stimulant  character  of  this  article,  it  is  only  suited  to  those 
cases  of  vomiting  in  which  inflammation  or  structural  disease  of  the 
stomach  is  not  present.  In  all  other  cases,  he  has  found  it  eminently 
advantageous  in  arresting  not  merely  vomiting  but  nausea.  In  colic,  the 
vomiting  attending  pregnancy,  sea-sickness,  &c,  he  recommends  its  use. 
One  or  two  drops  in  an  ounce  of  water  may  be  given  every  hour  or  half 
hour  till  the  effect  is  produced. 

3.  Diarrhoea. — Creasote  has  been  used  with  good  effect  in  simple 
diarrhoea,  cholera  morbus  and  cholera  infantum ;  also  as  a  gargle  in 
malignant  sore  throat. 

Modes  of  Administration. — Internally  it  is  used  either  in  pill  or  mix- 
ture. One  or  two  drops  dissolved  in  camphor  mixture,  or  the  same 
quantity  made  up  into  a  pill,  may  be  given  three  or  four  times  a  day. 
This  may  gradually  be  increased  to  eight  drops. 

Inhalation. — This  may  be  done  either  by  steeping  paper  in  it  and 
placing  this  in  approximation  with  the  nostrils,  or  by  heating  the  crea- 
sote in  the  neighborhood  of  the  patient,  so  that  he  cannot  fail  to  inhale 
it,  in  this  way ;  or  a  portion  of  it  may  be  poured  into  hot  water  in  a 
Mudffe's  inhaler,  and  the  creasote  vapor  inhaled  in  the  usual  manner. 

Externally  it  may  be  applied  in  the  form  of  lotion  or  ointment.  The 
lotion  is  made  by  adding  from  two  to  eight  drops  to  each  ounce  of 
distilled  water.  The  ointment  is  made  by  rubbing  up  ten  drops  with  an 
ounce  of  lard. 


NICRVINKtf.  45] 


For  dressing  ulcers  the  creasote  water  may  I"-,  used  first.     Sometimes 
the   purest  creasote  is  used  in  these  cases.     To  stop  hemorrhage  the 

best  way  is  to  imbibe  a  few  drops  of  pure  creasote  on  cotton  or  lint,  and 
apply  it. 


A  well  known  substance  of  peculiar  smell  and  bitter,  disagreeable 
taste.  Its  composition  is  very  complex,  its  most  important  soluble 
parts  are,  according  to  lierzelius,  a  pyrogenous  resin  united  vvitb  acetic 
acid,  creasote,  ammonia,  <fcc.  It  was  formerly  officinal  in  the  Edinburgh 
College.  An  infusion  of  hickory  ashes  and  soot  was  at  one  time  a  very 
popular  remedy  for  dyspepsia.  It  has  no  doubt  been  much  abused,  and 
is  now  rarely  prescribed  in  regular  practice.  It  is  now  chiefly  used  as 
an  external  remedy,  in  the  form  of  decoction  or  ointment.  The  decoc- 
tion is  made  by  boiling  a  gill  of  soot  in  a  pint  of  water  for  half  an  hour 
and  filtering.  It  is  used  in  obstinate  tetters,  porrigo,  psora,  and 
chronic  and  fistulous  ulcers,  also  in  scrofulous  ophthalmia.  A  decoction 
of  soot  is  a  very  good  injection  for  ascarides,  it  may  be  applied  to  burns 
when  the  suppuration  is  too  profuse. 

Acidum  Aceticum  Empyreumaticum. — This  is  the  pijrol'ujneons  acid, 
an  impure  acetic  acid  obtained  from  wood  by  destructive  distillation  in 
close  vessels. 

Properties, — The  pyroligneous  acid  is  a  fluid  of  a  brown  color,  having 
a  strong  and  smoky  smell.  Its  constituents  are  acetic  acid,  diluted  with 
more  or  less  water,  holding  tar  and  empyreumatic  oil  in  solution.  By 
purification  it  furnishes  a  strong  acetic  acid. 

Medical  Applications. — It  is  entirely  as  an  external  application  that 
it  has  been  used,  and  in  this  way  it  has  proved  exceedingly  useful  as  a 
local  stimulant  to  ulcers,  gangrene,  &c.  The  first  use  of  it  made  in  this 
way  was  by  Dr.  S.  Moore,  of  this  city,  in  the  case  of  mortification  of 
the  cheek.  This  was  in  1821.  Although  the  case  did  not  recover,  it 
corrected  the  foetor  in  a  decided  manner.  Since  then  it  has  been  used 
with  success  in  gangrene,  ulcers,  and  fungus  haematodes  by  Dr.  Simons 
of  Charleston  and  others. 


TONICS 


The  term  Tonic  is  used  to  designate  those  agents  which  have  the 
power  of  imparting  strength  and  energy  to  the  system.  Every  sub- 
stance, therefore,,  which  contributes  to  the  support  and  sustenance  of 
the  body  may  be  considered,  in  an  enlarged  sense,  as  a  tonic.  In  the 
Materia  Medica,  however,  the  term  is  of  more  limited  application,  and 
it  is  used  only  in  reference  to  certain  mineral  and  vegetable  substances, 
whose  immediate  and  primary  operation  is  to  quicken  the  appetite, 
promote  digestion,,  and  augment  the  strength.  This  they  do  even  if 
given  in  very  small  quantities.  If  their  use  be  continued,  the  system 
at  large  feels  their  influence.  The  pulse  becomes  full  and  strong — 
without,  however,  any  increase  in  its  frequency — the  muscles  are  more 
firm  and  solid,  the  energy  of  the  brain  and  muscular  system  is  aug- 
mented ;  in  short,  there  is  a  general  increase  in  the  power  of  the  whole 
system.  In  most  cases,  too,  the  fluids  participate.  The  blood  accord- 
ingly increases  in  quantity,  and  at  the  same  time  assumes  a  denser  and 
richer  appearance.  Such,  very  briefly  stated,  are  the  sensible  effects  of 
Tonics.  For  the  purpose  of  ascertaining,  if  possible,  what  the  changes 
are  which  the  various  organs  and  tissues  of  the  body  undergo  all  this 
time,  let  us  analyse  their  effects  a  little  more  in  detail. 

1.  Of  the  Local  Effects. — When  taken  internally,  the  primary  effect 
of  Tonics  is  upon  the  stomach,  and  a  peculiar  impression  is  made  upon 
the  mucous  lining  of  that  organ.  What  the  precise  nature  of  this 
impression  is  it  not  easy  to  say.  Analogous  in  many  respects  to  that 
made  by  stimulants,  it  nevertheless  differs  widely  from  it  in  not  being 
followed  by  any  general  excitement  of  the  system.  (Although  this 
statement  enters  almost  always  into  the  definition  of  the  tonic,  it  is 
surely  inaccurate.  Many  of  our  best  tonics  are,  when  used  in  full 
doses,  followed  by  general  excitement.)  In  many  cases,  too,  it  is 
associated  with  an  astringent  operation,  and  some  of  our  most  valuable 
tonics  are  also  remarkable  as  astringents.  Notwithstanding  this  a 
purely  tonic  effect  may  be  produced  without  any  astringent;  while,  on 
the  other  hand,  many  substances  act  as  astringents  without  being  at  all 
tonic.  It  would  seem,  therefore,  that  a  purely  tonic  effect  ^differs  from 
that    of   a   stimulant    or    an  astringent,  and  the_  nature  of  this  effect 


TONICS.  158 

consists  simply  in  an  increase  of  Ike  nervous  and  muscular  power  of  the 
part.    The  evidence  of  this,  of  course,  is  only  to  be  seen  in  the  chai 
wrought  in  the  functions.     Hence  it  is  that  tonics  quicker  the  appetite 
and  promote  the  power  of  digestion. 

Of  the  Remote  Effects. — 1.  On  the  Brain  and  Nervous  System. — 
To  the  brain  and  nervous  system,  tonics  impart  force  and  energy. 

On  the  Circulatory  and  Muscular  System. — The  action  of  toni< 
here  most  manifest,  and  shows  itself  in  the  increased  force  and  fulix 
the  pulse,  and  more  florid  hue  of  the  cheek,  as  well  as  in  the  increase  of 
strength  in  the  muscles.  On  the  urinary  system,  tonics  produce  an  effect, 
generally,  no  more  than  can  be  referred  to  the  improvement  they  make 
in  the  tone  and  vigor  of  the  system  at  large.  So  on  the  skin,  the  ehange 
manifested  by  heightened  color, agreeable  warmth,,  and  a  soft  perspirable 
surface,  is  to  be  attributed  to  the  general  effect  of  what  indeed  it  makes 
a  part,  rather  than  to  any  specific  influence  tkese  agents  kave  on  the 
skin.  All  their  effects  are  probably  secondary  to  the  power  they  have 
over  the  function  of  sanguification.  Tonics  improve  the  character  of  the 
blood,  increase  the  amount  of  solids  in  it,  enrich  it,  so  to  speak,  and  as  a 
consequence  of  this  change  we  have  the  functions  of  the  brain,  the 
lungs,  the  kidneys,  the  voluntary  muscles,  and  the  skin  performed  with 
more  energy  than  before. 

Circumstances  which  Modify  the  Effects  of  Tonics. — Like  most 
other  medical  agents,  tonics  are  modified  by  age,  sex,  temperament, 
climate,  &c. 

As  to  age  and  sex  a  common  principle  governs.  The  child  and  the 
woman,  from  their  delicacy  of  constitution,  are  more  easily  and  often 
more  favorably  affected  by  tonics  than  the  adult  or  the  male.  Yet  from 
their  greater  susceptibility  it  follows  that  the  agents  should  be  used  more 
carefully.  Especially  is  this  true  when  the  antiperiodic  effect  of  tonics 
is  to  be  obtained.  In  doing  this  great  caution  is  necessary,  lest  the  im- 
pression be  too  violent.  Pregnant  women  in  particular  are  likely  to 
suffer  in  this  way  ;  and  it  was  an  observation  of  Dewees,  that  bark  did 
uot  act  kindly  on  pregnant  women. 

Temperament. — The  mode  in  which  the  action  of  tonics  is  influenced 
by  temperament  is  obvious.  Excitable,  susceptible  persons  do  not  bear 
tonics  well.  The  same  thing  is  even  more  obviously  true  of  the  sanguine 
and  plethoric.  In  the  languid,  torpid,  sluggish  temperament,  on  the 
other  hand,  and  where  the  tone  is  below  par,  and  yet  the  nervous  sys- 
tem is  not  in  any  excitable  state,  they  show  their  best  powers. 

Climate. — The  warmer  climates,  by  the  increased  nervous  irritability 
they  produce,  render  the  system  generally  more  susceptible  to  the  action 
of  tonics ;  on  the  other  hand,  in  cold  climates  the  dull  and  unirritable 
condition  of  the  system  renders  it  comparatively  insensible  to  the  opera- 


454  MATERIA   MEDICA   AND   THERAPEUTICS. 

tion  of  these  agents.  This  state  and  its  influence  on  the  effects  of  tonics 
is  very  well  illustrated  by  the  diet  which  the  inhabitants  of  arctic  and 
torrid  climates  respectively  use.  By  the  former  the  grossest  food  and 
the  most  potent  stimulants  are  taken  in  the  greatest  quantities,  while 
the  other  delights  in  subacid  fruits,  and  a  diet  almost  exclusively  vege- 
table. Independent  of  climate,  season  also  influences  the  operation  of 
tonics. 

Mr.  Annersley  says,  that  at  Ningpua  in  India,  cinchona  proved  suc- 
cessful in  curing  agues  in  the  cold  weather,  while  it  utterly  failed  in  the 
hot. 

Repetition. — The  effect  of  tonics  is  impaired  by  repetition,  the  system 
becoming  habituated  to  their  use. 

Actual  Condition  of  the  System. — The  controlling  influence  which 
this  circumstance  has  over  the  effects  of  tonics,  is  well  seen  in  the  admi- 
nistration of  bark  in  fever.  If  the  system  be  in  a  proper  state,  if  it  has 
been  prepared  for  the  remedy,  a  few  doses  will  produce  the  desired 
effect,  while  without  such  preparation  the  same  impression  cannot  be 
made,  even  by  a  much  larger  quantity  ;  frequently,  indeed,  increasing 
the  dose  only  increases  the  difficulty. 

States  of  the  System  favorable  and  unfavorable  to  the  use  of 
Tonics.  —  Of  the  unfavorable  states  of  the  system  there  are  several, 
which  may  be  specified,  as  general  plethora,  organic  disease  of  the 
heart,  congestions  of  the  large  viscera,  an  excited  state  of  the  vascular 
system,  or  active  hemorrhage.  Under  any  of  these  circumstances,  the 
impropriety  of  using  tonics  is  so  obvious  that  no  words  can  make  it 
plainer. 

Therapeutic  Effects. — Tonics  prove  curative  of  disease  in  two  very 
different  modes  :  first,  by  increasing  the  general  tone  and  vigor  of  the 
body ;  second,  by  making  a  powerful  impression  on  the  nervous  system, 
and  in  that  way  counteracting  or  preventing  the  recurrence  of  periodical 
disease.  Accordingly  there  are  two  diseased  conditions  of  the  system  in 
which  these  agents  are  resorted  to,  viz.  that  which  is  marked  by  debility, 
loss  of  tone  and  vigor;  second,  that  of  which  periodicity  is  the  cha- 
racteristic element.  Of  the  application  of  tonics  to  the  first  of  these 
two  diseased  conditions,  I  need  not  say  much.  The  use  of  the  remedy 
flows  so  naturally  from  the  pathological  condition,  and  is  so  obviously 
connected  with  it,  that  it  rarely  gives  rise  to  much  difficulty.  Two  or 
three  cautions  are  necessary  ;  first,  remember,  that  in  an  over  dose  almost 
all  tonics  are  irritants,  and  will  exhaust  instead  of  invigorating  the  sys- 
tem. Use  them,  therefore,  always  in  moderate  doses.  Second,  the  vege- 
table tonics  are  always  safer,  and  very  generally  more  effectual  in  remov- 
ing debility.  To  this  the  only  striking  exception  is  where  the  debility 
is  the  direct  consequence  of  the  loss  of  blood.     In  this  case  the  chaly- 


TOBICS.  i56 

beates  arc  to  be  preferred.    Third,  tonics  will  never  produce  a  good 
effect  unless  the  digestive  organs  are  properly  prepared  for  their  u  e. 
This  principle  lies  at  the  very  foundation  of  .-ill  successful  use.  <,(  tonic 
in  diseases  of  debility. 

Tonics  as  Antiperiodics.— Muvu  the  operation  of  the  tonic  diffei 
widely,  not  in  degree,  but  in  kind,  from  its  invigorating  influence. 
Wc  desire  not  to  give  tone  to  the  stomach,  vigor  to  the  muscles,  energj 
to  the  brain,  to  augment  the  vital  power  throughout  the  system.  No- 
thing of  this  sort  is  aimed  at.  Wc  desire  to  make  upon  tin-  nerves,  the 
brain,  indeed  upon  the  whole  system,  an  impression,  excite,  if  you 
please,  an  irritation  which  shall  put  an  end  to  the  paroxysms  of  the  dis- 
ease we  combat,  by  rendering  the  system  insusceptible  of  it.  This  is 
the  true  theory  of  the  curative  influence  which  some  tonics,  though  by 
no  means  all,  have  over  periodic  disease.  Of  the  mode  in  which  this 
effect  can  be  secured  with  the  most  certainty  and  the  least  danger,  it  is 
necessary  that  you  be  well  informed.  The  rules  according  to  which 
antiperiodics  should  be  given,  are  : 

1st.  They  best  succeed  where  the  periodic  disease  is  simple :  has  no 
attendant  inflammations  or  congestions. 

2d.  If  the  heart  and  arteries  are  very  active,  pulse  full  and  frequent, 
skin  hot,  antiperiodics  are  far  less  likely  to  succeed  than  in  an  opposite 
state  of  the  circulation. 

3d.  They  have  a  more  decided  control  over  intermittent  than  remit- 
tent diseases;  the  latter  they  often  fail  to  cure,  and  not  very  infre- 
quently aggravate. 

4th.  They  very  rarely  succeed  where  the  stomach  is  foul  and  the 
bowels  costive.  Proper  purgatives  should  always  precede  the  use  of 
antiperiodics,  otherwise  they  are  generally  ineffectual,  and  often,  per- 
haps always,  unsafe. 

5th.  Antiperiodics  should  usually  be  given  during  the  intermission 
or  remission  of  the  disease.  This  rule,  however,  is  not  absolute,  as  it 
was  formerly  considered.  Antiperiodics  may  sometimes  produce  excels 
lent  effects  when  given  during  the  hot  stage.  [The  rule  in  reference  to 
the  administration  of  tonics,  only  during  the  intermission,  is  very  little 
regarded  by  the  practitioners  of  the  South  and  West.  In  the  grave 
forms  of  congestive  fever,  they  use  quinine  in  very  large  doses  at  all 
periods  of  the  disease,  and  without  regard  to  those  states  of  the  system 
which  have  been  supposed  to  forbid  its  use.  The  necessity  and  safety 
of  this  practice  have  been  abundantly  demonstrated,  and  it  is  now  very 
generally  adopted.  There  is  no  evidence  that  it  increases  the  intensity 
of  the  local  irritations.] 

6th.  They  may  he  given  either  in  moderate  doses,  continued  for  a 
number  of  days,  with  a  view  of  assisting  the  system  in  wearing  out  the 
disease,  or  they  may  be  given  in  a  single  intermission  in  large  doses,  so 


456  MATERIA    MEDICA    AND   THERAPEUTICS. 

as  to  produce  their  specific  irritation  on  the  system,  and  thus  strangle 
the  disease  at  once.  When  this  effect  results  from  the  use  of  quinine, 
it  is  called  quinization  or  cinchonization.  This  mode  of  using  either 
the  bark  or  any  other  of  the  forms  of  quinine  is  not,  when  properly 
watched,  dangerous.  Arsenic  is  much  more  dangerous,  and  though  it 
may  be  -(for  it  has  been)  given  in  large  and  rapidly  repeated  doses,  yet 
the  danger  is  by  no  means  trifling.  [It  has  long  been  my  opinion  that 
physicians  would  use  these  remedies  much  more  understanding^',  and 
that  students  would  get  a  clearer  idea  of  their  operation,  if  we  were  to 
brealc  up  this  class  of  tonics  into  stomachics  and  antiperiodics — to  one 
of  them,  iron,  the  term  hematic,  or  enricher  of  the  blood,  could  be  ap- 
plied. We  call  calumba  a  tonic,  and  give  the  infusion  to  debilitated 
persons  to  give  them  strength.  Now  does  any  one  suppose  that  the 
infusion  of  calumba  really  and  of  its  own  power  gives  strength  ?  Do 
we  not  all  know  that  strength  follows  the  use  of  this  drug  just  in  pro- 
portion as  it  gives  appetite  ?  Certainly  we  do.  The  remedy  increases 
the  appetite,  and  enables  the  stomach  more  perfectly  to  digest  the  food; 
in  truth,  it  is  a  stomachic.  Now  take  a  tonic  used  in  fever,  arsenic.  It 
too  is  a  tonic.  Now  let  us  refer  to  any  of  the  approved  definitions  of 
tonics. 

"  Those  remedies  which  moderately  and  permanently  exalt  the  ener- 
gies of  all  parts  of  the  frame  without  necessarily  producing  any  appa- 
rent increase  of  the  healthy  actions."     (  Wood  &  Bache,  p.  2.) 

Other  writers  speak  of  their  imparting  strength  to  the  whole  system. 
"  They  give  strength."  (Pereira.)  Now  is  it  "  by  giving  strength," 
"'by  exalting  the  energy  of  the  frame,"  that  arsenic  cures  fever?  No 
thinking  man  imagines  that  it  acts  in  any  such  way.  It  is  an  irritant ; 
it  excites  in  the  system  an  action  incompatible  with  the  diseased  action 
(as  Hunter  used  to  say),  and  thus  it  cures  ague.  As  to  iron  it  is  a  true 
nutrient  of  the  blood,  and  produces  its  effect  as  nutrient,  whether  it  be 
taken  as  it  exists  in  food,  e.  g.  in  muscular  flesh,  or  in  the  form  of  Val- 
let's  mass.  In  making  these  statements  I  do  not  claim  to  have  made 
discoveries  or  to  teach  what  was  not  known  before.  I  seek  only  to 
place  distinctly  before  the  student  facts  and  inferences  which  are  fami- 
liar to  practical  men,  but  which  have  not  yet  (in  the  books)  worked 
themselves  clear  of  old  prejudices.  Of  the  individual  tonics  treated  of 
in  the  following  pages,  calumba,  quassia,  gentian,  and  prunus  virgini- 
anus  are  stomachics — excitants  to  the  stomach,  increasing  appetite,  and 
aiding  digestion.  Cinchona,  arsenic,  and  salicine  are  irritant  antiperi- 
odics,  interrupting  paroxysmal  disease  by  exciting  an  action  or  irritation 
in  the  system  incompatible  with  the  diseased  action.  Iron,  as  before 
stated,  is  a  nutrient,  acting  exclusively  on  the  function  of  sanguification.] 


'IONICS.  I."m 


INDIVIDUAL    TONICS. 

Calumha. — This  is  the  product  of  the  Corral  as  pafwalas,  ;i  r.liinbing 
plant,  growing  native  in  the  forests  of  Mozambique,  on  the  south-eastern 
coast  of  Africa.  For  many  years  it  was  supposed  to  be  a  product  of 
Ceylon,  and  to  derive  its  name  from  the  principal  town  in  that  islandj 
from  whence  it  was  exported.  All  this,  however,  is  found  to  be  a  mis- 
take, and  the  name  is  derived  from  the  Portuguese  name  of  the  root. 
The  root  is  perennial,  and  dug  by  the  natives  in  the  dry  season  (March). 
The  offsets  from  the  main  root  are  the  part  used.  These  are  cut  into 
slices  and  dried  in  the  shade.  In  this  state  it  is  sent  to  India,  and  from 
thence  exported  to  different  parts  of  the  world. 

As  found  in  the  shops,  the  calumba  root  is  in  small  round  pieces 
about  one-third  of  an  inch  in  thickness,  and  from  one-half  to  three 
inches  in  diameter.  Sometimes  it  is  in  cylindrical  pieces  one  or  two 
inches  long.  The  cortical  part  of  these  pieces  is  externally  of  a  dark 
brown  color,  internally  of  a  light  yellow.  It  is  thick  and  easily  de- 
tached. The  internal  or  medullary  part  of  it  is  of  a  yellowish-green 
color,  light  spongy,  and  shrunk,  and  marked  with  concentric  circles 
and  radiating  lines.  Frequently  the  pieces  are  perforated  with  holes, 
occasioned  by  worms  attacking  the  starch.  The  calumba  has  a  faint 
aromatic  odor,  and  a  bitter  taste. 

The  best  pieces  are  those  which  are  heavy  and  solid  ;  they  are  brittle 
and  easily  pulverized;  the  powder  has  a  brownish-yellow  color.  Ac- 
cording to  analysis  this  root  contains  as  its  principal  constituents  a 
peculiar  bitter  principle,  called  calumbin,  gum,  and  a  large  proportion 
of  starch.     This  latter  constitutes  about  one-third  part. 

Calumba  is  soluble  both  in  water  and  in  alcohol. 

Adulterations. — The  genuine  calumba  root  is  said  to  be  very  scarce, 
and  the  roots  of  other  plants  are  frequently  sold  for  it.  In  France 
there  is  a  false  calumba  sold,  which  comes  from  the  northern  coast 
of  Africa,  differing  entirely  from  the  real  article.  In  this  country,  also, 
"we  have  an  article  which  is  sold  for  the  real  calumba.  This  is  the 
American  calumba,  the  product  of  the  Fraseri  walteri,  a  plant  growing 
in  the  south  and  west  of  the  Alleghany  Mountains,  but  never  found  on 
the  east  of  them.     This  is  distinguished  : 

1.  By  the  difference  in  external  appearance.  The  internal  structure 
of  the  Fraseri  is  more  uniform,  the  concentric  and  radiating  lines  are 
absent,  and  they  have  a  purer  yellow  color  instead  of  a  greenish  tinge. 
Their  taste  is  brittle  and  sweetish. 

Chemical  Tests. — These  all  depend  on  the  facts  that  calumba  contains 
a  large  proportion  of  starch  and  no  tannin,  the  Frasera,  on  the  contrary, 
containing  tannin  but  no  starch.      Of  course  a  decoction  of  genuine 


458  MATERIA   MKDICA   AND  THERAPEUTICS. 

calumba  takes  a  blue  color  from  a  solution  of  iodine  (iodide  of  starch), 
and  tincture  of  gall  throws  down  a  precipitate  (tannate  of  starch),  while 
neither  effect  is  produced  on  the  Frasera.  On  the  contrary,  with  the 
infusion  of  Frasera  the  sulphate  of  iron  produces  a  blackish  color,  and 
gelatine  throws  down  a  precipitate.  By  neither  agents  is  the  calumba 
affected.    ■ 

Effects, — This  is  a  most  valuable  article  and  peculiar  in  its  effects.  It 
is  a  pure  bitter  tonic,  without  any  astringency.  Its  operation  is  chiefly 
on  the  stomach  and  digestive  organs.  It  improves  the  appetite,  assists 
digestion,  and  corrects  the  gastro-intestinal  secretions.  It  sits  easy  on 
the  stomach,  and  sometimes  allays  vomiting.  This  may  partly  be  owing 
to  the  combination  of  such  a  large  proportion  of  starch,  giving  it  a  mu- 
cilaginous character.  Upon  the  general  circulation,  calumba  does  not 
exert  any  influence.     First  introduced  into  Europe,  1685. 

Forms  of  Administration. — 1.   Powder. — In  doses  of  from    grs.   x 

to  xxx.  U  "5?lf  "~*  L/7 

Infusion. —  \  ss  of  calumba  sliced.  Boiling  water  two  pints ;  mace- 
rate for  two  hours  and  strain. 

j)0Se. —  I  ij  two  or  three  times  a  day.  This  does  not  affect  the  salts 
of  iron,  and  therefore  is  a  good  vehicle  for  giving  them. 

Tincture. —  3  j  to  3  ij- 

Quassia  Excelsa. — A  native  of  the  woods  of  Surinam,  Jamaica,  and 
the  Caribbean  islands.  It  is  a  beautiful  tree,  rising  frequently  to  the 
heio-ht  of  one  hundred  feet,  and  often  ten  feet  in  circumference  near 
the  base.  The  part  used  in  medicine  is  the  wood  of  the  trunk  and 
branches,  As  found  in  the  market  imported  from  Jamaica,  it  is  in 
billets  of  various  sizes,  several  feet  in  length,  and  from  an  inch  to  a  foot 
in  diameter.  At  first  it  is  of  a  whitish  color,  but  on  exposure  to  the 
air  turns  yellow.  It  has  no  smell,  but  a  taste  intensely  bitter,  more  so 
than  that  of  almost  any  other  known  substance.  It  is  destitute,  how- 
ever, of  acidity  and  astringency.  It  is  with  great  difficulty  reduced  to 
powder. 

According  to  analysis,  its  chief  constituents  are  a  small  proportion  of 
volatile  oil,  peculiar  bitter  principle  (Quassia,  or  Quassite),  gummy 
extractive — pectin,  lignin,  and  various  salts.  All  the  active  properties 
of  Quassia  are  taken  up  by  water  and  alcohol,  and  the  infusion,  decoc- 
tion, and  tincture  are  all  equally  bitter. 

Effects. — Quassia  is  one  of  the  purest  of  the  simple  bitters.  It  acts 
as  a  tonic  to  the  digestive  organs,  without  producing  any  stimulant  or 
astringent  effects.  It  was  first  introduced  into  Europe  about  1756. 
This  is  used  by  the  brewers  to  impart  bitterness  to  beer. 

Form  of  Administration. — From  the  difficulty  of  pulverising  it,  it  is 
not  given  in  powder. 


TONICS.  459 

Infusion. — Hasped  wood  3  ij  j    water,  pint;    macerate  twelve  bom 

and  strain — dose  ?  ij  throe  or  four  times  ;i  day.  This  does  not  affect 
the  Salts  of  iron. 

Tincture. —  3  j  to  3  ij. 

|  Quassia  Cups  have  hecn  of  late  much  used.  They  give  the  Quassia 
bitter  to  water  in  a  few  moments  and  are  very  convenient. j 

S1MARUBA. 

The  tree  which  yields  this  is  the  Simaruba  officinalis,  XI.  S.,  growing 
native  in  Guiana  and  the  West  Indies.  It  is  a  tall  tree,  and  the  part 
used  in  medicine  is  the  bark  of  the  root.  The  wood  is  tasteless  and 
inert.  The  bark  is  imported  from  Jamaica  in  bales.  It  comes  in  thin 
pieces  several  feet  in  length,  and  a  few  inches  in  breadth.  It  is  folded 
lengthwise,  fibrous  in  its  structure,  flexible  and  tenacious.  Externally 
its  color  is  a  greyish  yellow,  internally  pale  yellow.  It  is  destitute  of 
smell,  and  has  a  bitter,  but  not  astringent  taste. 

According  to  analysis,  it  contains  Quassia.,  resinous  matter — an  aro- 
matic oil,  having  the  odor  of  benzoin — malic  and  gallic  acids,  in  very 
small  proportion— malate  and  oxalate  of  lime — oxide  of  iron — silica — 
ulmin  and  lignin. 

Both  alcohol  and  water  extract  the  active  properties  of  this  bark. 

Effects. — Analogous  in  its  effects  to  Quassia,  and  the  other  simple 
bitters.  It  acts  as  a  tonic  to  the  digestive  organs,  and  has  been  used 
in  cases  where  they  are  debilitated.  It  was  first  introduced  into  France 
in  1713  as  a  remedy  in  dysentery,  and  became  quite  celebrated  for  a 
time.     At  present  it  is  not  much  used. 

Mode  of  Administration. — From  the  difficulty  of  pulverizing  it  is  not 
much  used  in  powder. 

The  best  form  is  that  of  infusion.  This  is  prepared  by  macerating 
for  two  hours  in  a  covered  vessel  half  a  drachm  of  the  bark  in  half  a 
pint  of  water,  and  straining.      C    " 

Dose.—  §j   to   fij. 

GENTIAN. 

This  is  the  product  of  the  Gentiana  lutea,  a  perennial  plant  growino- 
indigenous  on  the  Alps,  Apennines,  and  Pyrenees.  It  is  about  three  or 
four  feet  high.  (Several  other  species  possess  analogous  medicinal 
properties,  and  are  used  for  similar  purposes.  The  roots  of  G.  purpurea, 
G.  punctata  and  G.  pannonica  are  scarcely  distinguishable,  the  G.  macro- 
phylla  is  used  in  Siberia,  the  G.  Catesbasi  is  officinal  in  the  U.  S.  Phar- 
macopoeia.) The  part  used  in  medicine  is  the  root.  This  is  collected 
and  dried  by  the  peasants,  and  imported  in  bales. 

30 


460  MATERIA   MEDICA   AND  THERAPEUTICS. 

As  found  in  the  market  this  is  in  pieces  of  a  foot  or  more  in  length 
and  one  or  two  inches  thick,  twisted  and  wrinkled  externally.  The 
texture  of  the  root  internally  is  spongy  ;  externally  the  color  is  yellow- 
ish brown,  internally  yellow.  The  smell  of  this  root  is  slightly  nause- 
ous, and  its  taste  intensely  bitter,  without  being  astringent.  It  yields  a 
powder  of  a  yellow  color. 

The  constituents  of  gentian  are  a  bitter  crystalline  matter  (gentianin), 
volatile  odorous  principle,  yellow  coloring  matter,  green  fixed  oil, 
uncrystallizable  sugar,  gum,  wax,  oil,  caoutchouc,  lignin,  free  organic 
acid. 

The  taste  and  virtues  are  extracted  both  by  water  and  alcohol. 

Effects. — This  is  another  simple  bitter,  having  no  astringency  or 
aroma,  producing  all  the  effects  of  a  pure  tonic.  Generally  speaking,  it 
does  not  cause  any  vascular  excitement.  If,  however,  it  be  taken  in  too  ' 
large  quantities  or  continued  too  long,  this  effect  is  produced.  Asa 
medicine  gentian  has  long  been  known.  It  is  said  to  have  received  its 
name  from  Gentius,  one  of  the  kings  of  Illyria,  who  was  conquered  by 
the  Romans  about  160  years  before  Christ. 

Forms  of  Administration.     Poivder. — Ten  to  thirty  grains. 

Compound  Infusion. — Made  with  bruised  gentian,  orange  peel,  cori- 
ander seeds,  and  a  little  diluted  alcohol.  Tonic  and  stomachic;  dose 
|  i  to   |  ij  three  or  four  times  a  day. 

Compound  Tincture. —  3  i  to   3  ij. 

Extract. — Dose,  grs.  x  to. -^issX  Nf 

Gmtianin. — The  peculiar  principle  contained  in  the  gentian,  neither 
acid  nor  alkaline.  Its  effects  are  the  same  as  the  root.  It  is  expensive, 
however,  and  possesses  no  advantages. 

Dose  in  pill  one  gr.  two  or  three  times  a  day. 

Gentiana  Catesbcei. — The  blue  gentian  has  a  perennial,  branching 
root,  somewhat  fleshy  ;  grows  in  the  swamps  of  Carolina,  flowering  from 
September  to  December.  As  a  medicine,  it  is  little  inferior  to  the 
European  gentian.  It  is  extensively  employed  at  the  South  as  a 
stomachic.  It  might  doubtless  be  made  to  take  the  place  of  the  foreign 
gentian. 

CINCHONA. 

The  cinchona  constitutes  an  extensive  genus  of  plants,  growing  at 
various  elevations  on  the  Andes,  in  South  America.  The  precise  number 
of  species  embraced  under  it  is  by  no  means  settled  by  botanists. 
According  to  Humboldt  there  are  eighteen.  [Not  more  than  thirteen 
are  known  to  yield  the  bark  of  commerce.]  Notwithstanding,  too,  all 
the  labor  and  research  which  have  been  spent  upon  the  subject,  it  is 
still  left  doubtful  from  which  of  the  species  the  different  kinds  of  bark 


TONICS.  1  (;  ] 

used  in  medicine  arc  dbtained.     It  will,  therefore,  be  quite  unm 
in  a  practical  point  of  view,  to  give  any  account  of  the  different  specie* 
which  have  been  described  l)y  botanists. 
The  cinchona  tree  is  of  considerable  si/.'',  varying  in  height  from  fifteen 

to  thirty  and  forty  feet.  The  mode  of  obtaining  the  bark  is  to  strip  il 
from  the  trunk  and  branches,  and  afterwards  dry  it  in  the  sun.  'I  b< 
period  for  doing  this  is  the  dry  season,  that  is,  during  the  months  of 
September,  October,  and  November.  During  the  process  of  drying  the 
bark  becomes  variously  quilled  ;  the  degree  of  it  depending  on  its  age 
and  thickness.  After  being  properly -dried  it  is  assorted  and  packed  in 
cases,  or,  as  they  are  called,  ceroom.  These  are  exported  from  vai  ion- 
ports  of  the  Pacific  coast  of  South  America. 

History* — By  whom  or  when  the  medicinal  properties  of  the  bark 
were  discovered  is  not  precisely  known.  By  some  it  is  supposed  thai 
they  were  known  to  the  Peruvians  long  before  the  conquest  of  their 
country  by  the  Spaniards.  This,  however,  is  rendered  highly  improba- 
ble by  the  statement  of  the  celebrated  traveller,  Humboldt,  who  says 
that  the  use  of  the  cinchona  "is  entirely  unknown  to  the  Indians 
generally  in  that  country ;"  and  he  adds,  that,  even  at  the  present  day, 
the  people  of  South  America  have  a  great  antipathy  to  the  use  of  this 
article,  and  in  the  treatment  of  their  fevers  in  the  very  country  in  whirl: 
this  tree  grows,  they  trust  entirely  to  .ether  remedies.  Humboldt  adopts 
the  opinion  that  the  discovery  was  accidentally  made  by  the  Jesuit 
missionaries,  some  of  whom  were  generally  well  instructed  in  medicine. 
What,  however,  more  immediately  brought  the  bark  into  notice  was  the 
circumstance  of  the  Countess  of  Cinchon,  wife  of  the  viceroy  of  Peru, 
being  cured  of  intermittent  fever  by  its  use.  This  took  place  in  1638, 
and  in  the  following  year  the  viceroy  returning  to  Spain  carried  some 
of  it  with  him.  This  probably  was  the  first  introduction  of  this  import- 
ant article  into  Europe.  Although  urged  to  it,  the  Spanish  physicians 
did  not  make  much  use  of  it  immediately,  and  its  spread  through 
Europe  was  chiefly  owing  to  the  Jesuits.  One  of  this  fraternity  in  Italy, 
a  Spaniard  by  birth,  the  Cardinal  de  Lugo,  was  the  chief  agent  in  pro- 
moting this  business.  At  his  request,  Pope  Innocent  X.  ordered  the 
bark  to  be  examined  by  his  first  physician,  who  declared  it  to  be  not 
merely  innocent  but  salutary.  Papal  patronage  being  now  extended  to 
it,  all  opposition  ceased  at  Rome,  and  this  place  became  its  principal 
mart.  In  1649,  the  provincial  fathers  of  the  Jesuits  brought  a  large 
quantity  of  it  from  Peru,  and  an  assembly  of  the  order  from  different 
parts  being  held  about  that  time,  it  was  distributed  on  their  return  in 
every  country  in  Europe.  It  is  from  these  circumstances  connected  with 
its  history  that  this  medicine  has  derived  most  of  the  names  by  which 
at  various  periods  it  has  been  known,  such  as  the  cortex  aud  pulvis  corai- 
tissce,  cortex  and  pulvis  de  Lugo,  pulvis  Jesiiiticum,  pulvis  patrum* 


462  MATERIA   MEDICA   ANI>  THERAPEUTICS. 

As  connected  -with  the  history  of  this  medicine,  it  is  not  a  little 
singular  that  the  most  violent  and  absurd  prejudices  existed  against  its 
use  for  a  long  time  after  it  was  first  introduced  into  practice.  By  some 
this  was  carried  so  far  as  to  assert  that  those  who  took  it  would  certainly 
die  in  the  course  of  a  year.  In  1652,  Leopold,  Archduke  of  Austria 
and  Governor  of  the  Netherlands,  was  seized  with  a  double  quartan,  for 
which  he  took  the  bark.  As  the  cure  proved  only  temporary,,  and  the 
fever  returned  in  thirty  days,  he  ordered  his  physician,  John  Jacob 
Chiefletins,  to  publish  a  history  of  the  ease,  with  a  view  of  dissuading 
from  the  use  of  so  deceitful  a  remedy.  Notwithstanding  this  it  secretly 
gained  ground,  and  in  consequence  of  the  traffic  in  it  being  chiefly 
monopolized  by  the  Jesuits,  the  price  became  most  exorbitant.  On 
some  occasions  it  was  actually  sold  for  its  weight  in  silver  and  gold.  In 
England  it  was  chiefly  brought  into  vogue  by  a  physician  of  the  name 
of  Talbot  (Sir  Robert  Talbot — Pereira),  who  cured  agues  by  a  new 
remedy  which  was  ascertained  to  be  entirely  made  of  cinchona.  So 
great  a  reputation  did  he  acquire  that  he  was  sent  for  to  France,  and 
cured  the  Prince  de  Conde,  and  Colbert,  minister  of  France,  "In  1679, 
the  Dauphin  son  of  Louis  XIV.  suffered  from  an  ague  which  the  Paris 
physicians  could  not  cure.  Talbot  was  called  to  Paris,  and  the  phy- 
sicians thinking  it  proper  to  examine  his  scientific  acquirements,  began 
by  asking  him,  '■Quid  est  febris?'  The  Englishman  frankly  answered, 
'I  do  not  know;  you,  gentlemen,  may  explain  the  nature  of  fever,  but 
I  can  cure  it,  which  you  cannot.'  This  finished  the  examination.  The 
Dauphin  took  the  remedy  and  was  cured." — Edinb.  Med.  and  Sur,  Jour, 
vol.  xxvii.,  p.  126, 

As  the  reward  of  Talbot's  success,  it  is  said  that  Louis  bought  the 
secret  for  2,000  louis  d'ors  and  an  annual  pension  of  2,000  livres* 
Besides  this,  Talbot  obtained  letters  of  nobility  and  a  monopoly  of  the 
article  for  ten  years.  In  consequence  of  this  the  price  of  Talbot's 
remedy  rose  to  a  most  extravagant  height — a  single  dose  of  it  cost  a 
louis  d'or,  and  a  pound  was  sold  for  100  louis. 

Physical  Properties. — The  Peruvian  bark  as  found  in  the  market 
comes  in  pieces  of  various  sizes ;  some  quilled,  others  flat,  of  different 
colors.  They  all  have  a  bitter  sub-astringent  taste  and  an  aromatic  odor, 
differing  very  much,  however,  in  intensity. 

Varieties  of  Bark. — The  varieties  of  the  Peruvian  Bark  are  exceed- 
ingly numerous,  and  different  classifications  of  them  have  been  proposed. 
The  one  most  generally  adopted  is  that  founded  on  their  color,  and  for 
practical  purposes  this  is  the  best.  They  are  accordingly  divided  into 
the  pale  barks,  the  yelloio  barks,  and  the  red  barks.  These  are  again 
divided  into  two  classes  according  to  the  color  of  the  epidermis.  We 
have  then, 

1.  The  barks  with  a  brown  epidermis,  pale,  yellow,,  and  red. 


TONICS.  468 

2.    The  barks  nnih  a,  while  epidermis,  pale,  yellow,  and  red. 

[Pereira  has  abundantly  proved,  that  tliis  classification  of  barks  bj 
their  color  is  objectionable.  For,  says  he,  "the  same  species  of  bark,  thai 
of  e.g.  C.  lancifolim,  in  tb<e  young  state  lias  a  brown  epidermis,  when  grown 

is  whitish  externally  owing  to  the  exfoliation  of  its peridmn  and  the  expo- 
sure of  its  white  micaceous  suberous  coat  Moreover,  the  yellow  or  red 
color  of  the  liber  cannot  he  relied  on  as  characterizing  any  particular 
sort  of  hark — since  the  same  species  is  under  some  cireunistaii'-es  p'l. 
under  others  yellow."] 

Of  the  Barks  with  a  brown  epidermis. — These  come  from  various  parts 
of  Peru  and  Quito  in  South  America,  and  contain  varying  quantities  of 
cinchonine  and  quinine. 

The  Pale  Barks. — These  come  in  quills  without  any  flat  pieces.  Thej 
are  of  various  sizes,  from  five  or  six  to  eighteen  inches  in  length,  and 
from  two  lines  to  an  inch  in  diameter.  They  come  both  in  single  and 
double  quills.  The  exterior  is  covered  with  a  brownish  epidermis  and 
is  marked  by  transverse  cracks  or  fissures.  They  are  also  frequently 
covered  with  lichens.  Internally  they  are  of  a  cinnamon  color,  varying 
in  the  shade  in  different  varieties.  The  poivder  which  they  yield  is  of  a 
pale  fawn  color,  differing  according  to  the  quality  of  the  bark.  Their 
taste  is  astringent  and  bitter,  without  being  unpleasant.  In  substance 
they  have  no  smell,  but  during  decoction  an  aromatic  odor  is  developed. 
When  broken  the  small  quills  have  an  even  fracture;  the  large  ones 
have  a  somewhat  fibrous  fracture.  These  barks  contain  both  cinchonine 
and  quinine.  The  proportion  of  cinchonine  is,  however,  larger  than  that 
of  quinine,  differing  in  this  respect  from  the  other  barks. 

There  are  several  varieties  belonging  to  the  class  of  pale  barks,  which 
are  known  in  commerce.     The  most  important  are  the  following: 

(a.)  The  Loxa  Bark. — So  called  from  the  province  from  which  it 
comes.  The  finest  kinds  are  also  known  by  the  name  of  crown  bark, 
from  the  fact  of  having  been  selected  specially  for  the  use  of  the  royal 
family  in  Spain.  This  bark  is  generally  admitted  to  be  the  product  of 
the   Cinchona  condaminea. 

(h.)  The  Lima  Bark. — In  Germany  called  the  Haanuco  Bark.  The 
first  of  these  names  is  derived  from  the  port  from  which  it  was  exported. 
The  second  from  the  city  Huanuco,  near  which  the  trees  grow. 

In  England  this  bark  is  called  the  silver  or  grey  bark.     [Probably 
from  the  0.  micrantha  and  the  C.  nitida — these  barks  are  mixed.] 
Besides  these  there  are  also: 
(c.)  The  Jaen  Bark,  or  ash  bark. 

{d.)  The  Huamalies,  or  rusty  bark,  names  derived  from  the  plaees 
from  which  they  come. 

In  this  country  all  the  pale  barks  are  known  in  commerce  by  the 
name  of  loxa  barks.  [IT.  S.  Disp.]     From  the  fact  that  the  pale  barks 


464  MATERIA   MEDICA   ANT>  THERAPEUTICS. 

contain  so  small  a  proportion  of  quinine,  they  are  not  much  used,  and 
the  sale  at  present  is  very  limited. 

2.  The  Yellow  Bark. — In  the  market  the  yellow  bark  is  known  by 
the  name  of  the  Calasaya  bark,  from  the  name  of  the  province  in  Peru 
where  it  is  collected. 

It  comes  both  in  quills  and  in  flat  pieces.  The  quills  are  distinguish- 
ed from  the  pale  bark  by  being  generally  larger  and  thicker,  the  epider- 
mis is  rougher  and  the  texture  of  the  bark  more  fibrous.  The  taste  is 
more  bitter  than  that  of  the  pale,  with  less  astringency.  Its  color  is 
orange  yellow.     It  yields  a  powder  of  the  same  color. 

In  its  chemical  composition  it  differs  from  the  pale  in  its  containing? 
a  larger  proportion  of  quinine  than  cinehonine. 

There  are  two  varieties  of  this  bark  found  in  the  markeS. 

1.  The  quilled  Calasaya  Bark. 

2.  The  fiat  Calasaya,  Bark. 

Both  these  come  from  the  same  tree  ;  the  only  difference  being  the 
quilled  is  taken  from  the  smaller  and  the  flat  from  the  larger  branches. 

Though  generally  supposed  to  be  the  product  of  the  cinchona  cordi- 
folia,  [Pereira  has  proved  that  it  is  from  the  C.  calasaya.] 

3.  The  Red  Bark. — This  is  so  called  from  its  color.  Like  the  Cala- 
saya bark,  it  comes  both  in  quills  and  flat  pieces.  They  vary  in  length 
from  two  or  three  inches  to  one  or  two  feet,  and  are  covered  with  a 
rough  epidermis.  The  color  of  the  powder  is  reddish  brown.  The  taste 
bitter  and  astringent,  though  less  so  than  the  pale.  This  bark  yields 
large  proportions  both  of  quinine  and  cinehonine.  The  tree  yielding  it 
has  generally  been  considered  to  be  the  Cinchona  oblong  i folia.  The  re- 
cent researches  of  botanists,  however,,  have  left  it  uncertain  what  the 
tree  is. 

The  foregoing  are  the  genuine  cinchona  barks% 

II.  Of  the  Cinchona.  Barks  with  a  White  Epidermis. — These  are 
known  by  the  name  of  Carlhagena  barks,  from  the  place  of  their  expor- 
tation. In  English  commerce  they  are  looked  upon  as  a  spurious  kind 
of  bark.     [Pereira,  vol.  ii.  p.  983.] 

All  these  have  a  whitish  micaceous  epidermis. 

They  contain  only  small  proportions  of  cinehonine  and  quinine.  One 
of  them  contains  a  peculiar  alkali,  called  aricinine^ 

There  are  several  varieties  of  these  barks  distinguished  by  their  color 
— the  pale,  yellow,  and  the  red. 

All  have  a  less  bitter  and  more  nauseous  taste  than  the  preced- 
ing. 

Besides  the  foregoing  there  are  a  set  of  barks  which  are  called  the 
false  cinchona  barks.  These,  from  their  resemblance  in  external  appear- 
ance to  the  cinchona  barks,,  have  been  at  different  times  introduced  into 
the  market  as  such.     They  are  not,  however,,  the  product  of  the  cin- 


tonics.  465 

chona,  but   of  other   trees,  and    contain    neither   quinine,  cinchonine, 
nor  aricinine.    Among  them  are  the  St.  Lucia  bark,  the  Caribbean  bark, 

&c. 

Chemical  Composition. — Although  subjected  to  a  great  number  and 
variety  of  analyses,  the  chemical  composition  of  the  Peruvian  bart  was 
very' imperfectly  understood  until  within  a  very  recent  period.  The  first 
approximation  to  any  acquaintance  witli  the  active  principle  ofthii  drug 
was -made  by  Dr.  Duncan  of  Edinburgh  in  1803.  It  had  for  sonic  time 
been  known  that  an  infusion  of  nutgalls  produced  ;i  precipitate  vvith 
infusions  and  decoctions  of  bark,  and  as  this  precipitate  differed  bott 
from  gelatine  and  starch,  the  oidy  other  substance  capable  of  precipitat- 
ing infusion  of  galls,  Dr.  Duncan  considered  it  as  a  new  and  distinct 
principle,  which  lie  called  cinchonin.  A  Portuguese  physician  by  the 
name  of  Gomez  prosecuted  the  investigation  of  this  principle  still 
further,  and  in  1810  described  its  properties  when  obtained  in  a  state  of 
purity.  It  was  reserved,  however,  for  two  distinguished  French  chemists, 
Pelletier  and  Caventou,  to  ascertain  the  true  character  of  this  principle, 
and  to  show  the  state  of  combination  in  which  it  exists  in  the  different 
kinds  of  bark.  By  them  it  was  shown  that  cinckonine  is  a  vegetable 
alkali,  and  that  it  exists  in  combination  with  a  peculiar  acid,  which  they 
called  the  kinic  acid.  In  addition  to  this  they  discovered  the  existence 
of  another  vegetable  alkali,  which  they  called  Quinine,  existing  also  in 
the  same  state  of  combination.  These  important  discoveries  were 
established  in  1820.  At  a  later  period  (1829)  the  same  chemists  dis- 
covered another  alkali  in  a  new  kind  of  cinchona.  This  they  called 
Aricinine. 

According  to  the  analysis  of  these  chemists,  the  genuine  Peruvian 
barks  contain  the  following  constituents :  Quina,  Cinchona,  Aricina 
Quinoidine,  Kinic,  Tannic  and  Kinovic  acids,  cinchona  red,  a  yellow 
coloring  matter,  a  green  fatty  matter,  starch,  gum,  and  lignin.  These 
exist  in  all  the  barks,  but  in  different  proportions.  Quinine,  cin- 
chonine,  aricinine  and  quinoidine  will  be  treated  of  hereafter;  kinic 
acid  exists  in  bark  combined  with  the  vegetable  alkaloids  and 
with  lime.  It  crystallises  in  prisms  with  rhombic  bases — CT  H4 
O  2  Ho. 

Kinovic  acid. — A  white  amorphous  substance  nearly  insoluble  in 
water,  soluble  in  alcohol  and  ether — in  the  bark  it  exists  united  with 
lime.— C12  H8  O9. 

Tannic  acid — called  cincho,  tannic  acid  differs  from  tannin  in  being 
less  astringent  and  in  giving  a  green  'color  with  the  salts  of  the  ses- 
quioxides  of  iron.  Its  compounds  with  acids  are  more  soluble  than 
those  of  tannin. 

Cinchona  red. — An  inodorous  reddish-brown  substance,  nearly  inso- 
luble in  cold,  but   rather  more  in    hot  water,  soluble    in  alcohol  and 


466  MATERIA    MEDICA    AND   THERAPEUTICS. 

ether  —  Berzelius  regards  it  as  a  product  of  the  oxidation  of  cincho- 
tannic  acid. 

Cinchona  bark  yields  its  active  principles  to  water,  wine,  and  alcohol. 
Cold  water  infused  upon  bark  for  a  certain  length  of  time,  acquires  the 
bitter  taste  and  odor  of  the  article.  If  assisted  by  moderate  heat,  the 
infusion  becomes  stronger,  and  while  it  continues  warm  is  perfectly 
transparent,  but  as  soon  as  it  cools  becomes  turbid.  By  the  addition  of 
the  mineral  acids,  particularly  the  sulphuric,  the  solubility  of  the  active 
principles  of  the  bark  is  increased.  This  acid  decomposes  the  ki nates 
and  forms  sulphates  of  cinchonine  and  quinine. 

Adulterations. — There  is,  perhaps,  no  medicine  which  has  suffered  so 
much  from  this  cause  as  the  bark.  According  to  Dr.  Paris,  it  "fell  into 
that  discredit  in  the  year  1779,  from  its  inability  to  cure  the  ague,  and 
it  was  afterwards  discovered  to  have  been  adulterated  with  bark  of  an 
inferior  species  :  indeed  Sydenham  speaks  of  the  adulteration  of  this 
substance  before  the  year  1678  ;  he  tells  us  that  he  had  never  used  to 
exceed  two  drachms  of  cinchona  in  the  cure  of  any  intermittent,  but 
that  of  late  the  drug  was  so  inert,  rotten,  and  adulterated,  it  became 
necessary  to  increase  its  dose  to  one,  two,  or  three  ounces."  The 
frauds  which  are  practised  in  relation  to  this  article  consist  not  merely 
in  using  inferior  kinds  of  bark,  but  in  using  the  dregs  which  are  left 
after  making  infusions,  decoctions,  and  tinctures.  These  reduced  to 
powder  are  of  course  totally  inert.  In  London  this  kind  of  fraud  is 
practised  to  a  great  extent.  The  only  way  to  avoid  this  is  to  procure 
the  bark  in  its  entire  state,  and  not  in  the  form  of  powder. 

If  ode  of  ascertaining  the  quality  of  the  bark. — The  best  kind  is  that 
which  contains  the  most  of  the  vegetable  alkalies. 

Test  for  the  Vegetable  Alkalies. — The  best  is  Tannic  acid.  This 
throws  down  the  alkalies  in  the  form  of  tannates.  Infusion  of  nut-gall 
is  the  form  in  which  this  test  is  used,  as  it  contains  large  proportions  of 
tannic  acid. 

The  best  bark,  therefore,  is  that  which  throws  down  the  most  copious 
precipitate  with  tannin. 

Effects  of  Cinchona. — Cinchona  possesses  in  an  eminent  degree  all 
the  properties  of  a  tonic.  Its  primary  operation  is  on  the  stomach. 
When  given  in  small  quantities,  it  simply  excites  the  natural  functions 
of  this  organ,  quickens  the  appetite,  and  promotes  digestion.  If  the 
quantity  be  large,  it  frequently  excites  local  heat  and  irritation,  not  un- 
frequently  accompanied  by  nausea,  vomiting,  and  purging.  If  the  use 
of  it  be  continued,  the  system  at  large  participates  in  its  effects.  The 
pulse  becomes  fuller,  stronger,  and  more  frequent,  the  head  is  affected 
with  a  sense  of  fulness  and  tension,  and  sometimes  actual  pain  ;  the 
secretions  are  impaired,  and  a  general  state  of  excitement  is  induced. 
When  given  in  states  of  debility  none  of  these  effects  appear,  and  the 


TONICS.  407 

only  evidence  of  action  of  the  article  is  to  be  found   in  tbe  increased 

strength  and  tone  of  the  system. 

Independent  of  the  general  effects  which  cinchona  produce  a  a 
tonic,  it  exercises  fi  peculiar  power  in  controlling  and  arresting  intermit- 
tent disease.  Although  there  arc  other  tonics  which  possess  this  pro- 
perty, there  is  none,  with  the  exception  of  arsenic,  which  can  at  all  be 
compared  to  it. 

Mode  of  Administration. — 1.  Substance. — In  tbe  form  of  powder  it 
may  be  given  in  doses  of  3  ss  to  3  j,  mixed  in  a  glass  of  port  wine  or 
some  aromatic.  At  present  the  bark  is  not  given  in  this  form,  being  in 
a  great  measure  superseded  by  the  sulphate  of  quinine. 

2.  Infusion. — The  simple  infusion  is  prepared  by  putting  a  pint  of 
boiling  water  on  an  ounce  of  bark.  Let  it  macerate  for  two  hours  in  a 
covered  vessel  and  then  strain. 

Prepared  in  this  way  the  infusion  contains  very  little  of  tbe  alkaline 

principles  of  the  bark.     The  activity  of  it  may  be  greatly  increased  by 

the  addition  of   3  i  sulphuric  acid.     This  converts  the  kinates  of  cincho- 

nine  and  quinine  into  sulphates,  wbicb  are  soluble.     The  dose  is   5  j  to 

3  ij  three  or  four  times  a  day. 

From  the  mildness  of  this  preparation  it  is  only  suitable  as  a  sto- 
machic, not  febrifuge. 

Alkalies,  alkaline  earths,  and  vegetable  astringents  are  incompatible 
with  it. 

3.  Decoction. — This  is  prepared  by  boiling  an  ounce  of  bark  in  a  pint 
of  water  for  ten  minutes  in  a  covered  vessel,  and  straining  while  hot. 
Long  boiling  greatly  impairs  tbe  virtues  of  the  bark.     Dose   3  i  to   1  ij. 

4.  Tincture. — This  is  prepared  by  macerating  six  ounces  of  bark  with 
two  pints  of  diluted  alcohol  for  fourteen  days  and  then  filtering.  It  is 
chiefly  used  as  an  adjunct  to  tbe  infusion  or  decoction.  In  doses  of  3  i 
to   3  iv  it  may  also  be  used  as  a  stomachic. 

Compound  Tincture  of  Bark. — This  is  the  celebrated  tincture  of  Dr. 
Huxbam.  It  is  more  agreeable  to  tbe  stomach  than  the  other  tinctures 
of  bark. 

5.  Extract. — [This  is  officinal,  but  almost  never  used.  Quinine  has 
banished  bark  so  absolutely  that  we  rarely  think  of  the  use  of  anything 
but  Huxham's  tincture  and  the  bark  jacket.  The  latter,  though  a  very 
homely,  is,  I  believe,  a  valuable  remedy  especially  for  children.] 


VARIOUS    MODES    OF    ADMINISTERING    BARK. 

1.  By  the  Stomach. — The  ordinary  and  preferable  mode. 

2.  Applied  to  the  SH71. — The  way  formerly  in  use  was  to  apply  what 
was  called  the  bark  jacket.     This  was  made  by  quilting  two  or  three 


468  MATERIA   MEDICA   AND   THERAPEUTICS. 

ounces  of  finely-powdered  bark  in  a  silk  or  muslin  handkerchief,  to  be 
worn  next  the  skin  around  tbe  waist.  Applied  in  this  way  the  bark 
has  frequently  succeeded  in  arresting  intermittent  fever. 

3.  By  the  Rectum. — In  this  way  the  effects  of  the  bark  may  also  be 
obtained.  For  this  purpose  3  ij  of  the  powder  may  be  injected  with 
three  or  four  ounces  of  thin  starch  ;  or  three  or  four  ounces  of  the  decoc- 
tion with  a  drachm  or  two  of  the  powder ;  and  to  retain  it,  ten  or  fifteen 
drops  of  laudanum  may  be  added. 

Of  the  Vegetable  Alkalies  in  the  Cinchona. — These  are  three, 
quinine,  cinchonine,  and  aricinine.  The  most  important  of  these  is 
the  first : 

1.  Quinine. — It  is  a  white  substance,  without  smell,  and  intensely 
bitter.  As  usually  prepared  it  is  not  crystallized,  though  it  may  be  so 
by  care ;  nearly  insoluble  in  water;  readily  soluble  in  alcohol  (espe- 
cially when  hot)  and  in  ether.  It  melts  at  300°,  becoming  brittle  on 
cooling.  It  possesses  alkaline  properties,  and  unites  with  the  acids 
forming  salts.  It  is  unalterable  in  the  air.  Infusion  of  nutgalls  throws 
down  a  precipitate  from  infusion  of  quinine  (tannate  of  quinine).  [This 
tannate  has  been  used  in  medicine  ;  it  is  tasteless,  and  equal  to  sulphate 
in  antiperiodic  power.]  The  only  salt  of  this  alkali  much  used  is  the 
sutyhate. 

Sulphate  of  Quinine. — This  is  prepared  by  boiling  yellow  bark  in 
powder  with  distilled  water  acidulated  with  sulphuric  acid.  This  is  then 
to  be  strained.  To  this  add  powdered  quicklime,  which  throws  down  a 
precipitate.  This  precipitate,  after  being  washed  with  distilled  water,  is 
to  be  dried,  and  then  digested  in  alcohol  with  a  moderate  heat;  the 
alcoholic  solution  is  then  to  be  poured  off  from  the  residuum,  and  put 
into  a  still  or  retort  and  evaporated,  till  a  brown  viscid  liquor  remains 
in  the  retort;  this  is  removed  from  the  retort,  and  as  much  diluted 
sulphuric  acid  added  as  will  completely  saturate  it.  Animal  charcoal  is 
then  added,  and  having  evaporated  the  liquor  sufficiently,  filter  it  while 
hot  and  set  aside  to  crystallize. 

The  rationale  of  this  process  is  the  following:  The  object  of  the  first 
part  of  the  process  is  to  make  a  sulphate  of  quinine,  which  is  soluble  in 
water ;  in  the  state  of  kinate  it  is  not  soluble.  In  the  first  boiling,  then, 
you  have  the  sulphate  of  quinine  in  solution,  but  mixed  with  various 
impurities. 

The  object  of  the  second  part  is  to  separate  these  impurities.  This  is 
done  by  adding  lime ;  this  decomposes  the  sulphate  of  quinine,  and 
throws  down  a  precipitate  composed  of  sulphate  of  lime  and  quinine, 
both  of  which  are  insoluble,  leaving  the  impurities  in  the  water. 

The  object  of  the  third  part  is  to  separate  the  sulphate  of  lime  from 
the  quinine.     This  is  done  by  boiling  in   alcohol,   which   dissolves  the 


TONICS.  469 

quinine,  nut  has  no  effect  on  tlic  sulphate  of  Rme«  The  pure  quinine  is 
thus  obtained  in  solution  in  alcohol;  the  animal  charcoal  is  added  to 
remove  the  coloring  matter,  and  the  alcohol  got  rid  of  by  evapo- 
ration. 

The  object  of  the  last  part  is  to  obtain  a  sulphate  of  rpuniin;  by  satu- 
rating quinine  with  diluted  sulphuric  acid.  It  is  in  fact  a  sub-  or  di- 
sulpliate. 

Physical  Properties. — This  salt  exists  in  fine,  silky,  needle-shaped 
crystals,  flexible,  and  of  a  pearly  aspect.  Its  taste  is  intensely  bitter. 
By  exposure  to  heat  it  melts  at  240°,  and  is  completely  volatilized. 
In  cold  water  it  is  very  slightly  soluble.  In  alcohol  it  is  very 
soluble,  and  slightly  in  ether.  With  sulphuric  acid  it  forms  a  auper- 
sulphate  [a  sulphate],  winch  is  much  more  soluble  in  water  than  the 
di-sulphate. 

Chemical  Composition. — Sulphuric  acid,  quinine,  and  water. 

Adulterations. — Being  an  expensive  article,  strong  temptations  are 
held  out  to  its  adulteration.  From  the  small  quantity  that  is  used  at  a 
dose,  it  is  evident  that  a  very  slight  sophistication  would  greatly  impair 
its  effects.  The  purity  of  the  article,  therefore,  is  a  matter  of  great  im- 
portance. 

It  is  adulterated  with  sulphate  of  lime,  gum,  starch,  sugar,  stearin, 
salicine.  To  ascertain  the  presence  of  these,  the  following  tests  may  be 
used : 

1.  Heat. — If  you  put  a  little  of  the  substance  on  a  piece  of  unglazed 
porcelain,  or  common  tobacco  pipe,  and  apply  heat,  the  pure  sulphate 
of  quinine  will  first  melt,  and  spread  a  little ;  it  then  turns  to  black  arid 
burns  away,  leaving  nothing  but  a  dark  stain,  with  a  peculiar  smell  of 
the  bark.  If  any  earthy  matter  be  present,  this  is  left  on  the  pipe. 
This  detects  sulphate  of  lime,  carbonate  of  lime,  etc. 

2.  Dissolve  a  little  of  it  in  pure  water  and  boil  it  in  a  silver  spoon. 
If  it  be  pure  the  solution  will  remain  transparent.  If  adulterated  with 
starch,  flour,  or  any  similar  substance,  a  paste  will  be  formed.  If  the 
sulphate  of  lime,  &c,  the  solution  will  not  remain  transparent. 

3.  Digesting  in  Alcohol. — If  it  be  digested  in  alcohol,  the  sulphate  of 
quinine  will  be  dissolved,  while  the  gum,  starch,  or  any  alkaline  or 
earthy  sulphates  will  be  undissolved. 

4.  To  detect  fatty  matter,  dissolve  in  water  acidulated  with  sulphuric 
acid.     This  dissolves  the  quinine,  but  does  not  the  fatty  matter. 

5.  To  detect  starch,  add  a  solution  of  iodine.  With  starch  this  strikes 
a  blue  color;  with  pure  sulphate  of  quinine,  it  throws  down  a  precipitate 
of  a  brown  cinnamon  color. 

6.  To  detect  sugar,  dissolve  the  sulphate  in  water  and  add  carbonate 
of  potash.  This  precipitates  the  quinine,  while  sulphate  of  potash  and 
sugar  remain  in  solution.     The  sugar  may  be  detected  by  its  sweet  taste, 


470  MATERIA.   MEDIC  A   AND   THERAPEUTICS. 

or  by  evaporating  the  liquid  to  dryness,  and  digesting  the  residue  with 
alcohol,  which  dissolves  the  sugar,  and  affords  it  on  evaporation. 

7.  To  detect  salicine,  add  sulphuric  acid.  This  turns  it  red  [not  unless 
the  salicine  is  in  the  proportion  of  Ty]. 

Effects. — The  sulphate  of  quinine  produces  the  same  effects  on  the 
system  as  bark,  and  may,  therefore,  be  use  as  a  substitute  for  it.  In 
the  smallness  of  the  doses  in  which  it  is  required  to  be  given,  as  well  as 
its  sitting  easy  on  the  stomach,  it  possesses  great  advantages ;  so  great 
that  it  has  nearly  superseded  the  bark. 

It  may  be  given  in  powder,  pill,  or  solution.  In  solution  it  requires 
the  addition  of  a  little  sulphuric  acid  to  make  it  soluble.  A  good  pre- 
paration is  the  following  : — 

$.  Sulph.  Quinine,  grs.  xii. 

Acid.  Sulph.  diluted,  gtt.  xii. 

Sac.  Alb. 

Pulv.  Gum.  Arabic,  aa  3  i. 

Aq.  Cinnamom.   §  iss.  M. 

The  dose  varies  with  the  object  had  in  view.  When  given  as  a 
simple  tonic,  one  gr.  three  times  a  day.  When  given  to  arrest  inter- 
mittent fever,  one  gr.  may  be  given  every  two  hours.  .  By  some  5  or  6 
grs.  are  given  at  once.  From  twelve  to  twenty-four  grains  should  be 
given  between  the  paroxysms.  In  the  malignant  intermittents  and 
remittents  of  the  South  a  very  much  larger  quantity  is  frequently 
required  to  control  the  disease.  Ten  and  twenty  grain  doses  are  com- 
mon, and  a  drachm  or  more  has  been  given  between  the  paroxysms. 
Maillot  gave  in  a  case  of  African  fever  one  hundred  and  twenty-eight 
grains  in  the  course  of  a  few  hours.  These  heroic  doses  should  not, 
however,  be  given  in  ordinary  cases,  as  they  are  beyond  a  doubt  not 
unattended  with  danger.  12  grs.  of  the  sulph.  quinine  are  equal  to  one 
ounce  of  bark. 

Various  modes  of  giving  the  Sulphate  of  Quinine. 

1.  By  the  Stomach. 

2.  By  the  JEndermic  method — applying  it  to  the  skin.  In  this  way  it 
produces  all  its  effects  on  the  system,  and  effectually  cures  intermittent 
fever.  Three  or  four  grains  of  it  finely  pulverized  are  to  be  sprinkled 
upon  the  denuded  cutis,  and  repeated  every  four  or  five  hours. 

3.  By  the  rectum.  This  is  a  good  mode  of  giving  it  and  acts  very 
effectually.  This  quantity  must  be  two  or  three  times  greater  than  that 
required  by  the  stomach.  It  may  be  mixed  with  a  couple  of  ounces  of 
starch.     I  have  arrested  intermittent  fever  in  this  way. 

Besides  the  Sulphate  of  Quinine,  there  are  other  salts  of  this  alkali 
which  have  been  used,  such  as  the  phosphate,  the  acetate,  and  the  like. 
They  all  operate  in  the  same  way,  but  do  not  possess  any  advantage 
over  the  sulphate. 


TONIC'S-  1  7  t 

2.  Cinchoninc. — This  is  another  of  the  alkaline  principle!  exi  ting  in 
the  bark.  It  is  found  in  the  greatest  abundance  iii  the  pub'  hark,  and 
exists  in  the  state  ofkinate.  Cinchorrine  is  a  white  crystalline  substance, 
without  smell  and  with  a  bitter  taste,  which  at,  first  is  not  perceptible, 
in  consequence  of  its  dillicult  solubility  in  the  saliva.  Its  solutions  are 
very  hitter;  in  cold  water  almost  insoluble;  in  hot  water  slightly  solu- 
ble; in  alcohol,  especially  boiling,  very  soluble;  with  the  acids  it  unites, 
forming  crystallizable  salts.  The  only  form  in  which  this  alkali  has 
been  used  in  medicine  is  that  of  the  sulphate.  In  its  operation  it  is 
very  analogous  to  the  sulphate  of  quinine,  and  is  used  in  the  same  way 
and  in  the  same  doses.     It  is,  however,  scarcely  at  all  employed. 

3.  Akicinine. — This  is  another  alkali  discovered  in  the  Arica  or 
Cusco  bark.  It  is  a  white  crystal! izable  substance,  resembling  cincho- 
ntne  in  most  of  its  properties.     It  has  not  yet  been  used  in  medicine. 

Therapeutic  Applications. — Bark  or  rather  its  alkaloids,  for  in  sub- 
stance it  is  scarcely  at  all  given,  is  used  almost  entirely  as  an  antiperi- 
odie,  and  as  such,  the  number  of  diseases  which  are  found  to  yield  to  its 
power  is  much  greater  than  was  formerly  supposed.  Wherever  the 
element  of  periodicity  characterizes  a  disease,  quinine  may  with  confi- 
dence be  appealed  to,  and  will  not  often  disappoint  our  hopes. 

CORNUS    FLORIDA. 

The  common  Dogwood,  also  called  the  New  England  Boxwood.  This 
is  a  forest  tree,  found  in  every  part  of  the  United  States,  although  it 
abounds  most  in  the  middle  States.  It  is  slow  in  its  growth,  and  the 
height  to  which  it  attains  is  from  fifteen  to  twenty  and  sometimes  thirty 
feet,  with  a  diameter  of  from  four  to  six  inches.  In  the  spring  it  bears 
a  profu^on  of  beautiful  large  white  blossoms,  which  are  succeeded  in 
the  autumn  by  clusters  of  berries  of  a  rich  red  or  crimson  color.  These 
berries  have  a  bitter  taste,  and  are  fed  upon  by  several  species  of 
birds.  • 

The  part  used  in  medicine  is  the  bark  of  the  root,  stem,  and  branches, 
all  of  which  possess  medicinal  properties,  though  that  of  the  root  is  the 
best.  As  found  in  the  shops,  this  is  in  pieces  of  various  sizes  more  or 
less  rolled,  of  a  brownish  color  externally'  and  yellowish  within.  It  is 
very  brittle,  and  yields  a  powder  of  a  brow7nish  color ;  it  has  little  or  no 
smell,  taste  bitter,  astringent,  and  somewhat  aromatic. 

According  to  analysis,  this  bark  contains  tannin,  gallic  acid,  gum, 
resin,  bitter  extractive,  and  mucilage.  By  Dr.  Carpenter  of  Philadelphia, 
it  is  said  also  to  contain  a  peculiar  principle,  to  which  he  has  given  the 
name  of  Cornia.  The  existence  of  this  principle  is,  however,  doubted 
by  some. 


472  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

The  best  menstruum  is  water,  and  in  this  it  is  more  soluble  than  the 
cinchonine. 

Effects.— In  its  effects  on  the  system,  the  dogwood  resembles  very 
nearly  the  Peruvian  bark.  This  has  been  very  fully  established  by  the 
experiments  of  Dr.  Walker.  It  has  accordingly  been  used  in  this 
country  as  a  substitute  for  the  bark,  and  with  complete  success,  acting 
not  merely  as  a  tonic,  but  as  an  antiperiodic  remedy.  Although  resem- 
bling, however,  the  Peruvian  bark,  it  is  not  to  be  compared  to  that 
article  in  general  efficacy,  and  therefore  is  comparatively  little  used. 

The  fresh  bark  is  apt  to  disturb  the  stomach  and  bowels.  This  is 
said  to  be  corrected  by  keeping  it  about  a  year  before  it  is  used. 

Mode  of  Administration. — In  substance  it  is  given  in  powder  in  doses 
of  from  3  j  to  3  ij.  The  more  common  form  is  the  decoction.  This  is 
prepared  by  boiling  for  ten  minutes  an  ounce  of  the  bruised  bark  in  a 
pint  of  water,  and  straining  while  hot.     Dose,    f  ij. 

Besides  the  Comus  Florida,  there  are  two  other  species,  the  Comus 
Circinata  and  the  Comus  Sericea,  whieh  possess  properties  analogous 
to  the  preceding. 


The  willow  is  a  most  extensive  genus  of  plants.  Nuttal  asserts  the 
number  of  species  to  be  a  hundred  and  thirty.  They  are  natives  of 
Europe  and  the  northern  and  temperate  regions  of  North  America. 
The  salix  alba,  or  white  willow,  the  one  commonly  used  in  medicine, 
has  been  introduced  into  this  country  from  Europe,  and  grows  very 
commouly.  Its  height  is  from  twenty  to  thirty  feet.  It  flowers  in 
April  and  May.    The  part  used  is  the  bark. 

As  found  in  the  shops,  it  is  generally  quilled  and  of  a  brownish  color, 
fibrous  in  its  texture,  and  not  easily  pulverized.  It  is  destitute  of  smell, 
and  has  a  bitter,  astringent  taste.  According  to  analyses  of  TPelletier 
and  Caventou,  the  willow  bark  contains  bitter  yellow  coloring  matter, 
green  fatty  matter  (like  that  foiHid  in  cinchona),  tannin,  resinous  extract, 
gum,  wax,  woody  fibre,  and  a  magnesian  salt. 

The  proportion  of  tannin  which  it  contains  is  so  great  that  it  has 
been  used  for  tanning  leather.  More  recently  the  existence  of  a  crys- 
talline substance  has  been  proved,  which  is  called  Salicin. 

The  willow  bark  yields  its  virtues  to  water. 

Effects. — This  acticle  is  analogous  to  cinchona  in  its  operation.  It  is 
tonic  and  astringent,  and  capable  of  arresting  intermittent  fever.  In 
every  respect,  however,  it  is  inferior  to  cinchona. 

It  is  given  in  substance  and  decoction,  and  in  the  same  doses  as  the 
cinchona. 

Salicin. — This  substance  consists  of  white  and  slender  crystals,  with 


TONICS.  173 

a  bitter  taste,  but  no  smell.     It  contains  no  nitrogen,  and  does  nol   form 
salts  with  acids;   it  is  not  a  vegetable  alkali.     If.  is  soluble  in  about 
twenty  parts  of  cold  water.     Tn  boiling  water  it  is  very  soluble,  a 
in  alcohol,  but  not  so  in  ether  or  the  essential  oils. 

Effects. — Analogous  to  the  sulphate  of  quinine,  but  far  inferior  in 
power.  In  many  cases  of  intermittent  fever  in  which  I  tried  it,  itfailed, 
and  they  were  afterwards  cured  by  the  sulphate  of  quinine. 

Dose. — From  ten  to  thirty  grains. 


LIRIODENDUON  TULIPIFEKA. 

This  is  one  of  the  most  magnificent  of  our  forest  trees,  distinguished 
alike  by  its  great  height,  its  beautiful  foliage,  and  superb  flowers.  It 
grows  in  almost  every  part  of  the  United  States,  and  not  unfrequently 
attains  the  height  of  one  hundred  and  thirty  feet.  Its  flowers  expand 
in  the  month  of  May,  and  are  exceedingly  beautiful,  being  variegated 
with  yellow,  orange,  and  green.  It  flourishes  more  particularly  in  the 
Western  States.  Its  common  name  is  the  tulip-tree,  or  the  American 
tulip-bearing  poplar. 

The  part  used  in  medicine  is  the  bark,  and  this  is  taken  from  the 
root,  trunk,  and  branches,  though  that  from  the  root  is  considered  the 
most  efficient. 

As  found  in  the  shops,  it  comes  in  pieces  of  various  sizes,  generally 
from  five  to  six  inches  long,  and  two  or  three  broad,  of  a  rough  and 
fibrous  appearance,  and  of  a  whitish  or  clay  color,  very  light,  and 
readily  broken.  It  has  a  heavy,  unpleasant  smell,  and  a  bitter,  aro- 
matic taste.  It  contains  gum,  resin,  iron,  muriatic  acid,  and  mucus. 
By  Professor  Emmet,  a  peculiar  principle,  which  he  calls  Liriodendrine, 
has  also  been  discovered.  This  is  a  white  crystallizable  substance,  not 
alkaline.  It  appears  to  hold  a  place  like  camphor  between  the  resins 
and  volatile  oils. 

The  virtues  of  this  bark  are  extracted  both  by  water  and  alcohol. 
Long  boiling  impairs  them. 

Effects. — This  substance  is  tonic,  and  at  the  same  time  stimulant  and 
somewhat  diaphoretic.  It  has  been  used  as  a  substitute  for  Peruvian 
bark  in  intermittent  fever. 

The  most  efficacious  form  of  giving  it  is  in  substance  in  the  form  of 
powder,  3  ss  to  3  ij.  The  infusion  (  3  j  to  pint  of  water),  3  j  to  3  ij. 
and  the  saturated  tincture  (  3  j)#are  also  used,  but  are  not  so  efficient. 

Of  the  Liriodendrine  no  use  has  yet  been  made. 


474  MATERIA   MEDICA   AND  THERAPEUTICS. 


This  substance  was  first  discovered  by  Oersted  in  1819.  It  is  found 
in  black  pepper,  white  pepper,  and  cubebs.  It  is  crystalline* perfectly 
white  when  pure,  but  as  generally  found  in  the  shops  of  a  yellow,  straw 
color,  without  smell,  and  almost  insipid.  It  is  not  alkaline,  as  was  at 
first  supposed.  In  cold  water  it  is  insoluble,  in  boiling  water  slightly 
so,  in  alcohol  and  acetic  acid  perfectly  soluble. 

Effects. — Tonic,  and  used  as  a  substitute  for  sulphate  of  quinine  in 
intermittent  fever ;  owing  to  its  great  insolubility,  the  best  form  of  giv- 
ing it  is  in_pill.  Dose,  grs.  vi  to  viii.  [Since  quinine  has  been  fur- 
nished at  a  reasonable  price  it  has  banished  all  vegetable  tonic  substi- 
tutes from  the  practice,  and  almost  from  the  memory  of  physicians.] 

PRUNUS    VIRGINIANA. 

This  is  the  wild  cherry  tree  [though  formerly  supposed  to  be  a  Pru- 
nus,  it  is  now  known  to  "Be  from  the  Cerasus  serotina],  a  large  and 
handsome  tree  growing  abundantly  in  different  parts  of  the  United 
States,  where  it  is  indigenous.  The  part  used  in  medicine  is  the  inner 
part  of  the  bark,  obtained  indiscriminately  from  all  parts  of  the  tree, 
though  that  of  the  root  is  the  most  active. 

As  found  in  the  shops  it  comes  in  brittle  pieces  somewhat  curved,  of 
a  cinnamon  color,  and  generally  destitute  of  epidermis.  It  has  a  bitter, 
aromatic  taste,  with  the  peculiar  flavor  of  the  bitter  almond.  When 
fresh  or  boiled  in  water  it  has  the  smell  of  peach  leaves ;  it  is  easily 
pulverized — the  powder  is  fawn-color. 

This  bark  yields  all  its  virtues  to  hot  and  cold  water.  It  was  sup- 
posed to  contain  hydrocyanic  acid  [but  it  does  not  pre-exist  in  it]. 

For  medicinal  purposes  it  should  be  used  recently  dried,  long  keeping 
impairs  its  virtues. 

Effects. — This  is  a  most  valuable  article.  It  is  tonic  in  each  operation, 
and  from  the  prussic  acid  which  it  is  supposed  to  contain,  somewhat 
narcotic.  If  used  in  sufficient  quantity  it  manifestly  diminishes  the  fre- 
quency of  the  pulse.  This  gives  it  a  peculiar  advantage  in  all  those 
cases  in  which  you  wish  to  allay  irritability,  and  at  the  same  time  .give 
tone.  In  dyspepsia,  in  the  hectic  of  consumption,  it  is  accordingly  found 
very  useful ;  used  also  in  inflammatory  fever,  far  inferior  to  cinchona. 

Form.  Powder. —  3  ss  to  3  i.  The  best  form  is  the  infusion.  This 
is  made  by  macerating  half  an  ounce  of  the  bruised  bark  in  a  pint  of 
cold  water  for  twelve  hours,  and  then*straining.  The  reason  for  using 
cold  water  is,  that  boiling  water  dissipates  the  volatile  principle  upon 
which  its  activity  appears  to  depend. 


TONICS.  415 

Two  or  three  ounces  of  this  infusion  may  be  taken  three  or  four  times 
a  day,  or  oftcner. 

FERRUM. 

Iron  is  a  metal  found  in  almost  every  part  of  the  globe.  It  is  of  a 
bluish  white  color,  and  has  a  high  degree  of  lustre;  it  is  very  ductile 
and  malleable,  with  a  specific  gravity  of  7.8.  Of  its  chemical  proper- 
ties it  is  not  necessary  to  speak  at  present. 

Effects  on  the  System. — As  a  general  tonic,  iron  may  be  ranked  as 
perhaps  the  first  on  the  list.  In  its  action  on  the  system  it  produces  all 
the  effects  which  have  been  described  as  characteristic  of  tonics.  It 
improves  the  condition  of  the  digestive  organs,  imparts  tone  to  the  mus- 
cular fibre,  increases  the  action  of  the  heart  and  blood-vessels,  and  quick- 
ens the  various  secretions.  Besides  these  general  effects  as  a  tonic,  there 
are  some  peculiarities  attending  the  action  of  this  agent  which  require 
to  be  noticed. 

1.  The  Permanency  of  its  Operation. — In  this  respect  iron  takes  the 
lead  of  all  other  tonics.  Whatever  may  be  the  cause,  there  is  none 
which  is  capable  of  imparting  such  general  vigor  to  the  system,  and 
none  whose  effects  are  equally  permanent. 

2.  Effects  of  Iron  on  the  Blood. — The  effect  of  iron  on  the  blood  is 
peculiar ;  other  tonics  produce  an  improved  condition  of  the  blood,  but 
they  do  it  indirectly,  and  as  a  consequence  of  their  influence  especially 
on  the  digestive  organs.  Iron  acts  directly  on  the  composition  of  the 
vital  fluid  itself.  This  is  proved  by  analysis  of  the  blood  before  and 
after  the  administration  of  iron.  [Simon  gives  a  table  of  the  results  of 
such  an  examination  made  on  the  blood  of  a  chlorotic  girl,  who  in  seven 
weeks  took  ten  ounces  of  the  tincture  of  iron  and  sixty-eight  grains  of 
metallic  iron. 

Before  the  use  of  the  iron,  the  blood  contained  in  1000  parts  871.5 
water,  128.5  solid  constituents,  haematin  1.431.  After  the  use  of  iron 
there  were  in  1000  parts,  water  806.5,  solid  constituents  193.5,  haema- 
tin 4.598  !  Well  may  Simon  say,  "this  change  in  the  composition  of 
the  blood  is  truly  surprising  !  Here  the  amount  of  solid  constituents 
is  increased  fifty  per  cent.,  and  that  of  haeuiatin  more  than  220  per  cent. 

The  change  in  the  health  of  the  patient  kept  pace  with  that  of  the 
blood.  The  results  of  the  researches  of  Andral  and  Gavaret  are  identi- 
cal with  those  of  Simon.  How  very  satisfactorily  does  this  analysis  ex- 
plain the  wonderful  power  of  iron  in  cases  of  prostration  from  uterine 
haemorrhage,  and  in  all  the  forms  of  anaemia. — Ed.] 

Preparations  of  Iron.  1.  Limatura  Ferri. — Iron  filings.  As  the 
common  filings  obtained  from  the  workshop  are  mixed  with  copper  filings 
and  other  impurities,  it  is  necessary  to  separate  them.     For  this  purpose 

31 


476  MATERIA    MEDICA   AND   THERAPEUTICS. 

a  sieve  or  piece  of  gauze  is  to  be  placed  over  them  and  the  iron  drawn 
through  this  by  running  a  magnet  over  it.  Even  after  this  process  the 
filings  are  not  perfectly  pure,  and  the  only  way  to  obtain  them  is  by 
taking  pure  iron  wire  and  filing  it. 

The  oxidation  of  iron  filings  can  be  prevented  by  mixing  them  with 
an  equal  weight  of  pure  dry  sugar.  The  mixture  must  not  be  exposed 
to  damp  ;  but  dry  air  will  not  oxydize  it.     (Jour,  de  Phar.) 

Effects. — In  this  form  iron  is  in  its  metallic  state,  and,  as  such,  like  all 
other  metals,  exerts  no  action  on  the  living  system.  To  produce  any 
effect,  it  must  be  oxydized,  and  therefore  the  filings  can  only  operate  as 
a  tonic  when  they  meet  with  an  acid  or  some  other  substance  in  the 
stomach  which  will  convert  them  into  an  oxide.  Hence  they  are  best 
suited  to  cases  marked  by  the  predominance  of  acidity  in  the  digestive 
•organs.  The  evidences  of  iron  filings  having  taken  effect,  are  fetid 
-eructations  and  the  black  color  of  the  faeces.  These  are  owing  to  the 
evolution  of  hydrogen  gas,  arising  from  the  decomposition  of  water  dur- 
ing the  oxidation  of  the  metal  in  the  stomach  and  intestines. 

Mode  of  Administration. — They  may  be  given  either  in  substance  or 
-pill — the  dose  from  5  to  20  grs. ;  in  substance  mixed  in  syrup,  to  which 
"powdered  ginger  may  be  added.  The  common  form,  however,  is  that 
of  pill,  made  with  the  bitter  extract  of  gentian. 

[Iron  reduced  by  Hydrogen. — This  preparation  has  been  lately  intro-       * 
duced  by  a  French  pharmacopist,  M.  Bouchardat.     It  seems  to  secure 
the  two  great  desiderata — an  impalpable  powder  and  perfect  purity.    As 
such  it  is  probably  a  valuable  addition  to  our  already  very  numerous  list 
ofchalybeates.-ED.] 

2.  Oxides  of  Iron. — There  are  two  oxides  of  this  metal,  Protoxide 
and  Sesquioxide  (peroxide). 

Protoxide. — It  consists  of  one  equivalent  of  iron,  28;  and  one  of  oxy- 
gen 8  =  36  Atom  No.  This  is  the  basis  of  the  native  carbonate  of  iron, 
and  of  the  green  vitriol  of  commerce.  According  to  Turner,  it  has 
never  probably  been  obtained  in  an  isolated  form.  Beck  says  that  it 
was  first  obtained  by  Stromeyer.  In  its  separate  form,  therefore,  it  is 
not  used. 

(b.)  Sesquioxide  of  Iron. — This  is  what  is  commonly  known  as  the 
red  oxide  or  peroxide.  It  is  found  native  and  prepared  artificially.  The 
red  hamiatite  is  this  oxide,  and  is  an  abundant  natural  production. 

It  is  prepared  by  subjecting  sulphate  of  iron  in  a  crucible  to  an  in- 
tense heat,  until  it  is  converted  into  a  red  substance.  It  is  washed  with 
boiling  water  and  dried.  In  this  process,  the  protoxide  of  the  sulphate 
is  converted  into  the  sesquioxide  by  the  addition  of  oxygen  which  it 
obtains  from  the  decomposition  of  a  part  of  the  sulphuric  acid — the  oxy- 
gen of  which  goes  to  the  protoxide,  while  sulphurous  acid  gas  is  evolved. 


TONICS.  477 

It  consists  of  one  equivalent  of  iron  28,  and  one  and  a  half  of  oxygen, 
12  =  40  Atom.  No.  It  is  of  a  reddish  brown  color,  task-less,  insoluble, 
and  is  not  attracted  by  the  magnet. 

Affects. — This  oxide  produces  the  effects  of  iron  on  the  Bystem, 
though  in  a  less  degree  than  the  other  preparations.  It  is  therefore 
not  used  by  itself.  In  the  state  of  hydrate,  the  sesquioxide  has  recently 
become  very  celebrated  as  an  antidote  to  arsenic.  This  may  be  pre- 
pared by  adding  ammonia  or  potash  or  their  carbonates  to  a  solution 
either  of  pernitrate  or  persulphate  of  iron.  The  precipitate  is  to  be 
washed  with  water  and  swallowed  undried.  (Pereira,  vol.  i.  p.  396.) 
To  be  efficacious  it  must  be  taken  in  as  large  doses  as  the  patient  can 
swallow  or  the  stomach  retain. 

Black  Oxide. —  Oxidum  Nigrum. — This  is  not  a  definite  compound 
of  iron  and  oxygen.  It  is  a  mixture  of  protoxide  and  sesquioxide.  It 
occurs  native  in  the  form  of  the  magnetic  iron  ore.  It  is  prepared 
artificially  by  taking  the  scales  detached  by  hammering  red  hot  iron 
(which  become  oxydized  during  the  process),  purifying  by  passing  the 
magnet  over  them,  then  pulverizing.  The  powder  is  of  a  dark  grey 
color,  without  smell  or  taste. 

Effects. — This  is  one  of  the  best  preparations  of  iron  and  dissolves 
very  readily  in  the  stomach  (much  more  so  than  the  sesquioxide),  and 
produces  the  ordinary  effects  of  this  metal. 

Dose. — From  5  to  20  grs.  two  or  three  times  a  day. 

[As  the  strength  of  this  preparation  is  very  apt  to  vary  with  the  vary- 
ing proportions  of  protoxide  and  sesquioxide,  the  Edinburgh  College 
has  ordered  a  preparation  in  which  the  two  oxides  are  united  (for  this 
is  a  true  chemical  union  and  not  a  mere  mechanical  mixture)  in  equal 
proportions.  This  is  equal  in  its  powers  and  not  liable  to  alter  by 
exposure  to  air.    (Vide  Christison,  p.  482.) — Ed.] 

3.  Carbonate  of  Iron. — There  are  two  modes  of  preparing  this  salt. 

(a.)  By  exposing  iron  wire  cut  into  small  pieces  to  the  action  of  air 
and  water,  until  it  is  converted  into  rust.  It  is  then  to  be  reduced  to 
powder  in  an  iron  mortar.  In  this  process  the  iron  is  oxydized  by  the 
oxygen  of  the  water,  which  is  decomposed,  while  carbonic  acid  is 
attracted  from  the  atmosphere.  When  prepared  in  this  way,  it  is  known 
by  the  name  of  the  carbonas  ferri  preparatus  or  the  rubigo  ferri. 

(b.)  Another  mode  is  by  the  joint  action  upon  each  other  of  solu- 
tions of  sulphate  of  iron  and  carbonate  of  soda.  A  double  decompo- 
sition takes  place.  The  sulphate  of  soda  remains  in  solution,  and  the 
hydrated  carbonate  of  iron,  being  insoluble,  is  precipitated.  The  super- 
natant liquid  is  then  poured  off  and  the  precipitate  dried  on  filtering 
paper  with  a  moderate  heat.  When  prepared  in  this  way,  it  is  called 
the  carbonas  ferri  precipitatus. 


478  MATERIA   MEDIOA   AND   THERAPEUTICS. 

As  found  in  the  shops,  this  preparation  of  iron  is  of  a  chocolate 
brown  color,  without  smell,  taste  slightly  styptic.  It  is  insoluble  in 
water.  Acids  dissolve  it  and  extricate  the  carbonic  acid  gas  with  effer- 
vescence. 

Although  so  called,  this  preparation  is  not  a  carbonate  of  iron. 
According  to  the  analysis  of  Mr.  Phillips,  it  is  a  compound  consisting 
of  variable  proportions  of  the  peroxide  and  the  protocarbonate  of  iron. 
As  commonly  found  in  the  shops,  Mr.  Phillips  states  the  proportions  to 
be  about, 

Carbonate  of  iron,     ....       4 

Peroxide  of  iron,      ....     96 


100 
and  when  prepared  with  the  greatest  care — 

Carbonate  of  iron,    .     .     .     .     40 
Peroxide  of  iron,      ....     60 


100 

The  rationale  of  all  this  is  the  following  : — When  prepared  by  pre- 
cipitation, as  already  stated,  a  hydrated  protocarbonate  of  iron  is  thrown 
down  of  a  green  color.  During  the  process  of  drying,  this  precipitate4 
is  changed  in  its  character.  From  the  great  affinity  of  iron  for  oxygen, 
the  protoxide  is  rapidly  converted  into  the  peroxide,  in  which  latter 
state  it  is  no  longer  capable  of  holding  the  carbonic  acid  in  combination. 
A  large  portion  is  thus  converted  into  the  peroxide.  A  portion,  how- 
ever, remains  undecomposed,  and  this  varies  according  as  the  drying  is 
slow  or  rapid. 

The  activity  and  efficacy  of  this  preparation  depend  upon  the  quan- 
tity of  carbonic  acid  held  in  combination. 

Effects. — Although  not  a  pure  carbonate,  this  is  a  valuable  prepara- 
tion of  iron.  It  is  mild  yet  efficacious,  and  it  may  be  given  in  large 
quantities  without  any  unpleasant  consequences.  The  ordinary  dose  is 
from  ten  to  thirty  grains  three  times  a  day.  To  obtain  the  full  effect  of 
it,  however,  it  is  necessary  frequently  to  give  it  in  doses  of  one,  two,  and 
three  drachms. 

From  the  great  propensity  which  the  carbonate  in  its  solid  state  has 
to  become  changed  in  its  character,  it  is  necessary,  if  you  wish  to  give 
it  in  its  pure  state,  to  administer  it  in  one  of  the  following  forms : 

(a).  Mistura  Ferri  Composita. — This  is  prepared  by  rubbing  up 
myrrh,  carbonate  of  potassa,  sulphate  of  iron,  rose  water,  spirit  of  laven- 
der, and  sugar.  The  mixture  is  to  be  poured  immediately  into  a  glass 
bottle  and  well  stopped.  This  is  an  imitation  of  Dr.  Griffith's  myrrh 
mixture.  In  this  preparation  the  sulphate  of  iron  is  decomposed,  and 
a  sulphate  of  potassa  and  a  protocarbonate  of  iron  formed.     The  mix- 


TONICS.  479 

ture  at  first  is  of  a  greenish  color;  if  exposed  to  the  ftir  it  loses  this,  in 
consequence  of  the  protoxide  being  converted    into  the  peroxide,  in 

which  case  the  protocarbonate  is  decomposed.  To  preserve  it,  there- 
fore, the  bottle  should  be  well  stopped,  or  what  is  better,  it  should  only 
be  prepared  when  required  for  use.  Dose,  one  to  two  fluid  ounces  two 
or  three  times  a  day — a  valuable  preparation. 

(b.)  Pill.  Ferri  Composite. — These  are  made  by  rubbing  up  myrrh, 
sulphate  of  iron,  carbonate  of  soda,  and  syrup,  and  made  into  pills. 

Here  the  same  changes  take  place.  The  sulphate  of  soda  and  the 
proto-carbonate  of  iron  are  formed.  They  should  only  be  made  when 
required  for  use.     Dose,  from  ten  to  twenty  grains. 

(c.)  Saccharine  Carbonate  of  Iron. — Recently  it  has  been  ascertained 
that  if  the  proto-carbonate,  when  first  precipitated,  and  before  drying, 
be  mixed  with  syrup  or  sugar,  it  will  be  retained  in  its  original  state 
without  undergoing  any  change. 

This  is  an  exceedingly  valuable  discovery,  and  gives  us  a  most  excel- 
lent and  reliable  chalybeate.  [It  is  introduced  into  the  U.  S.  Pharma- 
copoeia, under  the  name  of  PiL  Ferri  Carbonatis.] 

4.  Proto- Sulphas  Ferri. — This  is  known  by  the  name  of  Vitriol  of 
Mars,  green  vitriol,  copperas,  and  Sal  Martis.  It  is  prepared  by  the 
action  of  sulphuric  acid  upon  iron.  It  is  crystalline,  with  a  disagreea- 
ble, styptic  taste ;  its  color,  when  recently  formed,  is  bluish  green.  It 
is  soluble  in  about  two  parts  of  cold  and  in  three  fourths  of  its  own 
weight  of  boiling  water ;  in  alcohol  it  is  insoluble.  When  exposed  to 
the  atmosphere  it  not  merely  effloresces,  but  undergoes  other  chemical 
changes — oxygen  is  absorbed  from  the  atmosphere. 

Effects. — This  is  one  of  the  most  active  of  the  preparations  of  iron, 
being  powerfully  tonic  and  astringent.  If  given  in  too  large  doses  it 
acts  as  a  local  irritant  to  the  stomach  and  bowels,  causing  nausea,  grip- 
ing, vomiting,  and  purging.  Although  a  valuable  form  of  this  metal,  it 
cannot  be  given  with  the  same  freedom  as  some  of  the  other  prepara- 
tions ;  nor  is  it  so  well  suited  to  those  cases  where  the  long-continued 
use  of  ferruginous  preparations  is  required. 

Mode  of  Administration. — The  dose  is  from  one  to  five  grains,  and 
the  best  form  of  giving  it  is  that  of  pill  made  up  with  myrrh,  ammoniac, 
or  some  of  the  bitter  extracts.  Solution  is  an  objectionable  form,  unless 
the  water  be  previously  boiled  to  expel  the  atmospheric  air  from  it.  If 
this  is  not  done  oxygen  is  absorbed  and  the  sulphate  is  decomposed. 

5.  Ferrocyanas  Ferri,  also  called  the  Prussias  ferri,  or  prussiate  of 
iron.  This  is  the  principal  ingredient  in  the  common  pigment  called 
Prussian  blue  ;  and  it  is  in  this  latter  form  that  it  is  used  in  medicine. 

Prussian  blue  as  found  in  the  shops  is  in  cakes  of  a  deep  blue 
color,  without  taste  or  smell.  It  is  insoluble  both  in  alcohol  and  in 
water. 


480  MATERIA   MEDICA   AND  THERAPEUTICS. 

i 

It  is  a  compound  of  the  ferrocyanate  of  the  peroxide  of  iron  and  of 
alumina. 

Effects  on  the  System, — Prussian  blue  is  a  mild,  though  efficacious 
preparation  of  iron.  It  sits  well  on  the  stomach,  seldom  producing  any 
nausea  or  local  irritation.  In  its  general  operation  as  a  tonic  it  appears 
to  act  with  more  promptness  than  the  other  preparations  of  iron. 

Mode  of  Administration. — A  good  way  of  giving  it  is  in  powder,  in  a 
cup  of  milk,  in  doses  of  from  three  to  six  grains,  repeated  about  three 
times  a  day. 

6.  Proto-Phosphas  Ferri. — This  is  prepared  by  the  joint  action  of 
solutions  of  sulphate  of  iron  and  phosphate  of  soda — a  double  decompo- 
sition takes  place,  the  phosphate  of  iron  being  precipitated,  while  the 
sulphate  of  soda  is  held  in  solution. 

It  is  a  powder  of  a  pale  blue  color,  and  without  taste  or  smell. 
Effects  on  the  System. — It  is  a  mild  preparation,  but  is  little  ..ysed. 
Mode  of  Administration. — It  is  given  in  doses  of  from  eight  to  ten 
grains,  three  times  a  day.  Q^t* 

7.  Tartras  Ferri  et  Potassje.— Also  called  Ferrum  Tartarizalum, 
or  Tartarized  Iron.  This  salt  is  prepared  by  the  joint  action  of  iron 
and  supertartrate  of  potassa  with  water.  Here  the  iron  is  first  oxydized 
by  the  oxygen  of  the  water  and  the  atmosphere,  and  afterwards  dissolved 
by  the  excess  of  acid  of  the  supertartrate  of  potassa.  A  double  salt  is 
thus  formed,  consisting  of  the  tartrate  of  iron  and  potassa. 

As  found  in  the  shops,  this  preparation  of  iron  is  a  powder  of  a  green- 
ish brown  color,  without  smell,  and  has  very  little  of  the  disagreeable 
taste  of  iron.  It  is  readily  soluble  in  water  \  on  exposure  to  the  atmo- 
sphere it  becomes  moist.  Hence,  it  is  necessary  to  keep  it  in  closely 
stopped  bottles. 

Effects  on  the  System. — As  a  ferruginous  preparation  this  has  many 
advantages.  From  its  want  of  taste  and  its  easy  solubility,  it  is  one  of 
the  best  forms  for  giving  this  metal  to  children.  It  is  less  constipating 
and  less  exciting,  too,  than  some  of  the  other  forms  of  this  metal. 

[This  is  the  Chalybeate  most  used  by  Ricord  in  sloughing  chancres, 
intractable  sores  in  broken  constitutions,  <fcc,  &c. — Ed.] 

Mode  of  Administration.  —  The  dose  is  from  ten  to  thirty  grains, 
and  may  be  given  in  bolus  or  solution.  The  solution  will  keep  a  consi- 
derable length  of  time  without  decomposition.* 

8.  Ferrum  Ammoniatum. — This  is  a  mixture  of  muriate  of  ammonia 
and  permuriate  of  iron.     It  is  very  soluble  and  deliquescent. 

*  "  Occasionally,  it  deposits  tartrate  of  lime,  this  being  an  accidental  impurity  in 
the  supertartrate  of  potash." — Phillips,  p.  106. 


TONICS.  481 

Effects  on  the  System. — A  feeble  and  uncertain  preparation,  very  little 
used  at  present.  Unlike  some  of  the  other  ferruginous  preparations  it  is 
sliglitly_ajjerj§nfc*  a,  C 

Mode  of  Administration. — It  may  be  given  in  doses  of  from  grs.  x  to 
xv,  three  times  a  day. 

10.  Tinctura  Fehhi  Sesquichloridi,  called  muria  ted  tincture  of  iron 
This  is  prepared  by  dissolving  the  carbonate  of  iron  of  the  shops  in 
muriatic  acid,  and  then  adding  rectified  spirits  to  the  clear  liquor.  As 
already  stated,  the  snbearbonate  of  iron  consists  of  a  mixture  of  peroxide 
of  iron  and  the  carbonate  of  the  protoxide  of  iron.  By  the  action  of 
muriatic  acid,  a  protochloride  and  a  perchloride  of  iron  are  formed.  By 
the  action  of  muriatic  acid  on  the  alcohol,  a  little  muriatic  ether  is  also 
formed.  This  preparation,  therefore,  consists  of  protochloride  of  iron, 
perchloride  of  iron,  muriatic  ether,  and  alcohol. 

As  found  in  the  shops,  this  tincture  is  of  a  reddish  brown  color,  with 
a  styptic,  astringent  taste,  and  a  smell  somewhat  resembling  ether. 

Effects. — This  is  one  of  the  most  certain  and  active  of  the  preparations 
of  iron.  If  given  in  moderate  quantities,  it  sits  well  on  the  stomach.  In 
large  doses  it  acts  as  a  local  irritant  on  the  digestive  organs. 

Mode  of  Administration. — It  is  given  in  doses  of  from  ten  to  thirty 
drops  in  a  cup  of  water,  to  be  repeated  three  or  four  times  a  day. 

Lactate  of  Iron. — This  is  obtained  by  the  direct  action  of  a  dilute 
solution  of  lactic  acid  on  iron  filings.  This  is  digested  by  a  gentle  heat 
for  six  or  seven  hours  ;  after  this  the  liquid  is  boiled,  filtered,  and  con- 
centrated until  crystals  are  formed  on  cooling. 

This  salt,  which  is  the  lactate  of  the  protoxide  of  iron,  is  generally  met 
with  in  the  form  of  a  yellowish  or  greenish  white  powder,  sometimes  as 
greenish  acicular  crystals.  But  little  soluble  in  water,  reddens  litmus 
paper,  and  has  a  ferruginous  taste.  When  dissolved  in  water,  the  iron 
passes  to  a  higher  state  of  oxidation,  and  the  salt  becomes  yellow.  This 
salt  is  highly  commended  by  some  of  the  French  physicians,  and  thought 
by  them  to  be  superior  to  all  other.  This  is  denied  by  Mialhe  and 
Pereira. 

It  may  be  given  in  pastilles  or  lozenges — the  sugar  preventing  the 
further  oxidation  of  the  iron. 

Dose. — Four  to  ten  grains,  three  or  four  times  a  day. 

Citrate  of  Iron. — This  preparation  was  first  introduced  in  1831  by 
M.  Beral  of  Paris.  It  is  prepared  by  taking  a  boiling  solution  of  crystal- 
lized citric  acid  in  water,  and  saturating  it  with  the  moist  hyd rated  per- 
oxide of  iron.  When  cold  the  solution  is  to  be  filtered,  and  when  spread 
upon  glass,  speedily  dries  and  separates  itself  from  the  glass  in  thin 
lamina."    -^**-r-**>*  >-*-«L— 


482  MATERIA  MEDICA  AND   THERAPEUTICS. 

This  salt  is  uncrystallizable,  strongly  reddens  litmus  paper,  and  has 
an  acid  but  not  unpleasant  taste.  It  is  very  slowly  soluble  in  cold 
"water.  In  boiling  water  it  is  readily  soluble.  Its  pleasant  taste  has 
commended  it  to  the  use  of  some  practitioners,  but  it  is  not  much  used. 

Dose. — 5  to  10  grs.  three  times  a  day. 

Ammoniated  Citrate  of  Iron. — This  is  prepared  by  adding  to  the 
acid  citrate  of  iron  in  solution  (as  above  described)  ammonia,  so  as  to 
neutralize  the  acid.  A  double  salt  is  thus  obtained  of  a  neutral  cha- 
racter, and  which  dissolves  much  more  readily  in  cold  water  than  the 
citrate. 

This  is  an  excellent  chalybeate.  It  has  no  disagreeable  taste,  is 
entirely  devoid  of  irritating  power,  is  readily  soluble  in  water,  and  forms 
a  rather  agreeable  draught.  That  it  may  be  given  with  alkaline  car- 
bonates is  also  a  great  advantage.  It  is  the  preparation  of  iron  best 
adapted  to  the  strumous  affections  of  children  and  invalids  of  delicate 
stomachs.     It  is  highly  commended  by  Dr.  Golding  Bi-rd  in  lithuria. 

Ferro-Tartrate  of  Ammonia. — May  be  prepared  by  adding  caustic 
ammonia  to  a  solution  of  tartrate  of  iron.  The  green  solution  thus  ob- 
tained is  to  be  evaporated  to  dryness. 

In  the  form  of  shining  brittle  fragments  of  a  deep  red  color,  very 
soluble  in  water,  and  strongly  saccharine  in  its  taste.  Acts  like  other 
ferruginous  preparations.  Its  advantages  are,  great  solubility,  being 
palatable,  and  not  readily  decomposed. 

Dose. — For  an  adult  5  toJLgrSjjn^  powder,  pill,  or  solution  ;  may  be 
taken  in  porter  without  being  detected.  s.   -,  ^^^      ^-r 

ARGENTUM. 

Silver  is  found  either  pure,  in  combination  with  other  metals,  such  as 
gold,  mercury,  arsenic,  and  antimony,  or  in  the  state  of  sulphuret,  either 
pure  or  mixed  with  the  sulphurets  of  copper,  lead,  and  antimony.  The 
principal  mines  from  which  it  is  obtained  are  those  of  Mexico  and  Peru, 
and  in  Europe  those  of  Hungary  and  Transylvania. 

Properties. — Silver  is  of  a  pure  white  color,  and  susceptible  of  receiv- 
ing a  lustre  surpassed  only  by  polished  steel ;  without  smell  or  taste. 
In  malleability  and  ductility  it  is  inferior  only  to  gold  ;  when  pure  it  is 
so  soft  as  to  be  cut  with  a  knife;  at  a  red  heat  it  fuses.  Its  specific 
gravity  is  10.5.  The  only  pure  acids  that  act  upon  silver  are  the  sul- 
phuric and  nitric.  The  sulphuric,  however,  only  acts  upon  it  with  the 
aid  of  heat.  The  silver  of  the  shops  generally  contains  traces  of  gold 
and  copper. 


TONICS.  483 

Preparations  of  Silver. — In  its  metallic  state  silver  is  not  supposed 
to  exert  any  agency  upon  the  human  system.  The  preparation  of  it 
which  has  heen  most  generally  used  is  the  nitrate.  Very  recently  the 
oxide  has  also  be^n  introduced  into  practice. 

Nitrate  of  Silver. — Lapis  Infernalis,  Lunar  Caustic. — This  ifi  pre- 
pared by  taking  an  ounce  and  a  half  of  silver  and  dissolving  it  in  a  mix- 
ture of  one  ounce  of  nitric  acid  and  two  ounces  of  distilled  water.  This 
forms  a  solution  which  by  evaporation  yields  crystals.  By  subjecting 
these  crystals  to  a  suitable  heat,  they  become  fused,  and  in  this  state 
arc  cast  into  small  sticks  in  circular  moulds  prepared  for  that  purpose. 

During  this  process  a  portion  of  the  nitric  acid  is  decomposed  into 
nitric  oxide  gas  and  oxygen.  The  nitric  oxide  escapes,  and  by  union 
with  the  oxygen  of  the  atmosphere  forms  red  nitrous  acid  vapors,  while 
the  oxygen  unites  with  the  silver  to  form  oxide  of  silver.  With  this 
the  remaining  undecomposcd  nitric  acid  unites  and  forms  the  nitrate  of 
silver. 

When  pure  the  crystals  of  nitrate  of  silver  are  transparent  and  color- 
less. In  the  form  of  stick,  the  pure  nitrate  is  of  a  white  color,  with  a 
taste  metallic  and  bitter;  breaks  with  crystalline  fracture.  On  expo- 
sure to  the  atmosphere,  it  does  not  deliquesce.  When  subjected  to  the 
action  of  heat,  it  fuses ;  if  the  heat  be  increased  it  is  decomposed,  nitric 
acid  and  oxygen  are  evolved,  and  metallic  silver  left.  When  exposed 
to  a  strong  light,  it  becomes  blackish,  especially  if  in  contact  with  any 
carbonaceous  matter.  This  is  owing  to  the  reduction  of  a  part  of  the 
silver  to  a  metallic  state.  (Phillips.)  It  is  soluble  in  alcohol  and  in 
water. 

Purity. — To  be  perfectly  good  it  should  possess  the  following  pro- 
perties : 

■  1.  The  stick  should  be  of  a  white  color  ;  when  colored  it  shows  some 
impurity ;  when  the  color  is  blackish  it  has  been  contaminated  with, 
organic  substances,  or  formed  by  moulding  in  iron  vessels ;  when  the 
color  is  very  pale  it  may  be  owing  to  the  presence  of  reduced  silver,  or 
a  small  quantity  of  copper. 

2.  The  fracture  should  be  crystalline  and  radiated  ;  when  the  frac- 
ture is  conchoidal  it  is  impure. 

3.  It  should  be  completely  soluble  in  distilled  water  ;  any  deposit 
shows  an  impurity. 

4.  The  solution,  when  tested  with  ammonia,  should  throw  down  an 
abundant  precipitate  (the  oxide  of  silver),  which  should  be  entirely 
redissolved  on  adding  an  excess  of  ammonia.  The  solution  should  then 
remain  colorless — the  least  tinge  of  blue  indicates  the  presence  of 
copper. 

The  substances  which  may  be  deposited  by  impure  lunar  caustic  dur- 


484  MATERIA   MEDICA   AND  THERAPEUTICS. 

ing  its  solution,  are  oxide  of  copper,  reduced  silver,  and  chloride  of  silver. 
On  separating  these  deposits  from  the  solution,  their  character  may  be 
ascertained  in  the  following  way  : 

1.  If  the  "  deposit"  dissolves  easily  in  nitric  acid  without  producing 
red  fumes,  and  gives  a  solution  which  becomes  blue  when  tested  with 
ammonia,  it  is  oxide  of  copper. 

2.  If  it  dissolves  slowly  in  nitric  acid  under  the  production  of  red 
fumes,  and  forms  a  solution  which  does  not  become  blue  with  ammonia, 
it  contains  reduced  silver.  In  this  case  the  sticks  of  lunar  caustic  pos- 
sess a  corroded  appearance,  and  seem  to  contain  air  bubbles. 

3.  If  it  is  insoluble  in  nitric  acid,  but  easily  soluble  in  ammonia,  or  if 
it  readily  becomes  black  in  the  light,  it  is  chloride  of  silver. 

The  foregoing  are  impurities  arising  during  the  manufacture  of  the 
article,  owing  to  impurities  in  the  silver,  and  in  the  nitric  acid. 

Sometimes,  however,  it  is  fraudulently  adulterated,  and  chiefly  with 
nitre  and  nitrate  of  lead. 

Tests. — 1.  If  on  adding  ammonia  to  a  solution  of  it  only  a  slight  pre- 
cipitate take  place,  the  adulteration  may  be  suspected. 

2.  To  a  solution  add  hydrochloric  acid,  until  no  more  of  the  precipi- 
tate take  place.  This  throws  down  all  the  silver  in  the  form  of  chloride 
of  silver.  Then  separate  the  solution  from  the  precipitate  by  filtration  ; 
evaporate  it  to  dryness.  If  a  residue  remain,  throw  it  on  burning  coals, 
and  if  it  deflagrates  it  proves  the  presence  of  nitre. 
■  Effects  on  the  System. — The  most  interesting  and  important  of  these 
are  the  effects  which  it  produces  when  used  as  a  local  application.  Of 
these  we  shall  speak  under  another  head.  When  taken  internally  its 
primary  local  effect  varies  with  the  dose ;  if  given  in  considerable 
quantities  it  acts  as  a  local  irritant,  producing  heat  about  the  fauces, 
nausea,  and  griping,  succeeded  by  actual  vomiting  and  purging;  if  this 
quantity,  however,  be  small,  no  sensible  effect  of  this  kind  is  produced, 
and  the  impression  which  it  makes  on  the  nerves  of  the  stomach  is 
soothing  and  tonic.  This  is  particularly  illustrated  in  irritable  states  of 
the  organ.  Besides  the  local  effect  thus  produced,  an  analogous  one  is 
extended  to  the  brain  and  whole  nervous  system.  What  the  precise 
nature  of  this  impression  is  [we  know  not].  It  has  been  found  to  cure 
epilepsy,  but  its  modus  operandi  is  quite  unknown. 

A  very  curious  occasional  result  of  the  use  of  this  remedy  is  the  dis- 
coloration of  the  skin.  The  color  is  bluish,  slate  color,  or  bronze,  it  is 
usually  permanent,  but  in  some  cases  has  faded  away.  The  corion  is 
the  essential  seat  of  this  discoloration,  which  is  usually  referred  to  a 
deposit  of  chloride  of  silver  in  the  skin,  blackened  by  exposure  to  air. 
It  is  generally  incurable,  but  has  been  -diminished,  in  one  instance  at 
least,  by  weak  nitric  acid  washes  [Pereira,  sub  voce).  In  one  instance 
the   mucous   membrane    of  the  stomach  and  intestines  was  similarly 


tonics.  485 

tinted,  and    in    another   all    the    internal    viscera    wen:    more    or    li 
blue. 

The  diseases  in  which  niirutc  of  silver  has  been  most  given  are  epi- 
lepsy, chorea,  and  some  forms  of  dyspepsia.     It  appears  to  produce  the 

best  effects  in  those  cases  of  dyspepsia  where  there  is  evidence  of  mor- 
bid sensibility  of  the  gastric  nerves.  /  y 

Oxide  of  Silver. — This  is  obtained  by  adding  lime  water  or  pure 
baryta  to  a  solution  of  nitrate  of  silver,  then  washing  and  drying  the 
precipitate.  Here  the  nitric  acid  unites  with  the  lime  or  baryta,  while 
the  oxide  of  silver  is  precipitated.  In  the  state  of  hydrate,  it  is  of  a 
black  color ;  when  anhydrous,  it  is  of  an  olive  color,  tasteless,  and  inso- 
luble in  water. 

Effects. — Oxide  of  silver  is  a  much  less  active  agent  than  nitrate.  It 
has  little  of  its  caustic  or  irritating  power,  and,  perhaps,  because  it  less 
readily  forms  soluble  compounds  in  the  stomach,  is  less  apt  to  produce 
irritation  there.  It  is  not  so  prone  to  discolor  the  skin,  probably  being 
less  active  both  for  good  and  evil.  It  is  used  in  the  same  cases  as  the 
nitrate. 

It  has  been  found  useful  in  uterine  diseases,  especially  in  uterine 
neuralgia  (irritable  uterus),  and  in  some  of  the  forms  of  leucorrhoea 
andTlysmenorrhoea.     [Very  little  used  and  might  be  less.] 

Dose. — One  or  two  grains,  three  times  a  day  in  a  pill  or  powder. 


ARSENIC. 

In  the  form  of  some  of  its  combinations,  this  metal  was  known  to  the 
ancients.  By  Dioscorides  the  sulphuret  of  arsenic  is  noticed.  The 
peculiar  nature  of  the  metal  was  first  shown,  however,  by  Brandt  in 
1733. 

It  is  an  exceedingly  brittle  metal  of  a  steel  grey  color,  and  when  re- 
cently broken  has  a  strong  metallic  lustre.  Its  texture  is  crystalline, 
destitute  of  taste — at  356c  F.  it  volatilizes  without  being  fused,  and  gives 
out  a  garlic  odor.  By  exposure  to  the  air  it  is  speedily  tarnished  and 
converted  into  a  black  powder,  which  is  called  fly  powder.  This  is  a 
mixture  of  the  metal  and  the  oxide. — Sp.  gr.  7.5. 

In  its  metallic  state  arsenic  is  sometimes  found  native — most  com- 
monly,  however,  it  is  found  in  combination  with  other  metals,  such  as 
cobalt  and  iron.     It  is  not  used  in  medicine. 

With  oxygen  it  forms  two  compounds,  arsenious  acid  and  arsenic  acid. 
The  first  is  the  only  one  used  in  medicine. 

Arsenious  Acid. — Commonly  called  the  oxide  of  arsenic.     This  sub 


486  MATERIA   MEDICA  AND  THERAPEUTICS. 

stance  when  first  prepared  is  in  large  masses,  having  a  vitreous  fracture 
and  perfectly  transparent.  After  a  while  it  becomes  white  and  opaque, 
this  change  taking  place  gradually  from  the  surface  to  the  centre.  Its 
specific  gravity  is  3.7.  It  has  no  smell,  not  even  in  a  state  of  vapor,  as 
the  garlic  odor  belongs  only  to  metallic  arsenic ;  it  has  little  or  no  taste ; 
it  is  very  sparingly  soluble  in  cold  water,  more  so  in  hot.  In  alcohol 
and  oils  it  is  soluble — at  380°  it  volatilizes,  and  the  vapors  condense 
unchanged  on  cold  surfaces  in  the  form  of  crystals. 

Purity. — As  commonly  found  in  the  shops  it  is  in  powder.  In  this 
state  it  is  apt  to  be  mixed  with  flour,  powdered  chalk,  or  sulphate  of 
lime.  This  may  be  detected  by  putting  some  of  it  on  the  point  of 
a  knife  and  subjecting  it  to  heat.  The  arsenious  acid  will  be  dissipated, 
while  the  impurities  will  remain  behind. 

Physiological  Effects. — When  given  in  small  and  repeated  doses 
arsenic  acts  on  the  system  without  producing  any  visible  effect,  except 
in  the  alleviation  of  the  disease  for  which  it  may  be  administered. 
Even  in  such  doses,  gastric  irritation  marked  by  heat  of  the  throat, 
oesophagus,  and  stomach,  sometimes  nausea,  and,  though  rarely,  gastro- 
dynia  often  appear.  Febrile  movement  with  dryness  of  the  skin,  languor, 
lassitude,  and  want  of  sleep,  irritation  of  the  bowels  with  griping, 
redness  of  the  eyes,  with  a  degree  of  conjunctivitis,  and  dropsical 
swelling  of  the  face,  are  frequently  noticed  {oedema  arsenicalis).  When 
any  of  these  symptoms  show  themselves,  the  use  of  the  article  should 
be  immediately  stopped;  if  this  is  not  done,  symptoms  of  the  slow 
poisoning  by  arsenic  appear.  Sometimes  the  digestive  apparatus,  at 
others  the  nervous  system  first  feels  its  influence.  Hahnemann,  quoted 
by  Dr.  Christison,  says  there  is  a  gradual  sinking  of  the  powers  of  life, 
without  any  violent  symptom,,  a  nameless  feeling  of  illness,  failure  of 
strength,  aversion  to  food  and  drink,  disrelish  for  all  the  enjoyments  of 
life,  sometimes  redness  of  the  conjunctiva,  followed  by  a  cutaneous 
eruption,  at  others  irritation  of  the  stomach,  and  even  in  some  cases 
ptyalism. 

The  symptoms  produced  by  large  poisonous  doses  of  arsenious  acid  put 
on  two  very  different  forms.  In  the  one  they  indicate  gastro-enteritis, 
while  in  the  other  there  is  little  irritation  of  the  digestive  canal,  the 
poison  chiefly  affecting  the  nervous  system.  In  the  first,  nausea, 
vomiting,  burning  pain  in  the  throat  and  stomach,  with  a  sense  of  heat, 
dryness  and  constriction,  incessant  thirst,  with  a  difficulty  of  swallowing, 
all  point  to  irritation  of  the  stomach  ;  diarrhoea,  tenesmus  with  a  hard 
and  tense  abdomen,  and  occasionally  heat  and  excoriation,  all  show  that 
the  whole  track  of  the  alimentary  canal  is  involved.  The  pulse  is  quick, 
small,  and  irregular,  the  breathing  short  and  laborious,  tongue  dry  and 
furred  with  cold  clammy  sweats.  Tremblings,  cramps  with  occasional 
delirium,  prove  that  the  nervous  system  has  not  escaped. 


TONICS.  487 

In  the  second  form  of  acute  poisoning  by  arsenic,  the  symptoms  oi 
gastric  or  intestinal  irritation  are  either  absent  or  very  slight;  in  their 
stead  we  see  faintness,  convulsions,  paralysis,  delirium,  sometimes  insen- 
sibility.    These  symptoms  ordinarily  follow  a  very  large  dose. 

Uses. — Arsenic  lias  been  chiefly  used  as  an  anti-periodic  in  miasmatic 
fevers,  and  in  neuralgic  and  other  affections,  when  they  take  the  perio- 
dic form.  For  this  purpose,  6,  10,  or  even  20  drops  may  be  given  three 
times  a  day.  It  should  not  be  continued  long  at  this  rate.  It  is  some- 
times combined  with  quinine,  and  succeeds  where  each  separately  has 
failed.  Arsenic  is  of  great  value  in  most  of  the  scaly  diseases  of  the 
skin,  as  lepra,  psoriasis,  &c.  Five  drops,  three  times  a  day,  is  about  the 
proper  dose.  Arsenic  is  occasionally  employed  as  a  caustic ;  its  use  is 
always  attended  with  danger. 

Modes  of  Administration,  (a.)  Substance. — It  is  sometimes  used  in 
this  form  made  into  pills  in  doses  of  from  T\  to  T\  of  a  grain.  The  pills 
should  be  prepared  with  great  care.  For  this  purpose  the  arsenic  should 
be  intimately  rubbed  up  with  white  sugar,  and  then  made  up  with  crumbs 
of  bread. 

(b.)  Solution. — The  common  form  in  which  it  is  used  in  solution  is 
the  liquor  arscnicalis,  or  the  liquor  potassce  arsenitis,  commonly  called 
Fowler's  solution. 

This  is  prepared  by  taking  of  arsenious  acid,  finely  pulverized,  sixty- 
four  grains,  and  boiling  it  in  a  solution  of  sixty-four  grains  of  carbonate 
of  potassa  in  a  pint  of  distilled  water,  until  the  arsenic  is  completely  dis- 
solved. To  the  solution,  when  cold,  add  four  fluid  drachms  of  compound 
spirit  of  lavender,  and  then  as  much'  distilled  water  as  will  make  the 
whole  solution  up  to  a  pint. 

In  this  preparation  the  arsenious  acid  combines  with  the  potassa, 
while  the  carbonic  acid  escapes.  It  is,  therefore,  a  solution  of  the  arsenite 
of  potassa  colored  by  the  spirit  of  lavender.  It  is  a  transparent  fluid, 
having  the  taste,  smell,  and  odor  of  lavender.  Each  fluid  drachm  of 
this  solution  contains  half  a  grain  of  the  arsenious  acid. 

The  average  dose  is  ten  drops  two  or  three  times  a  day  for  an  adult. 

Dr.  Fountain  objects  to  this  mode  of  giving  Fowler's  solution.  He 
says  that  given  in  this  way  it  has  to  be  continued  for  some  time,  and  it 
then  is  apt  to  accumulate  in  the  system,  and  produce  unpleasant  effects. 
He  gives  it  in  doses  of  ten  drops  every  two  hours  (in  intermittent  fever), 
so  as  to  give  60  or  100  drops  during  a  single  intermission,  and  then 
stops  with  it  altogether.  In  this  way  he  has  used  it,  he  says,  in  a  great 
number  of  cases,  and  never  witnessed  any  bad  effects  from  it. 

(c.)  Arsenite  of  Soda. — This  is  given  in  solution  : 
3-  Arsenitis  sodae  grs.  iv. 

Aquae  distillat.   §  iv.  M. 

This  is  a  preparation  used  by  Biett  in  the  Hospital  of  St.  Louis,  at 


488  MATERIA   MEDICA   AND   THERAPEUTICS. 

Paris,  as  a  substitute  for  Fowler's  solution.  Eacli  drachm  of  this  con- 
tains one  eighth  of  a  grain  of  the  salt.  From  twenty  to  thirty  drops  is 
a  dose.  » 

(d.)  Arsenite  of  Ammonia. — This  is  also  used  in  solution  : 
R,.  Arsenitis  ammonias  grs.  iv. 

Aq.  dist.  .  3  iv.  M. 

This  is  also  used  by  Biett  in  the  same  way  as  the  preceding. 

Liquor  Arsenici  et  Hydrargyri  Iodidi. — Solution  of  the  Iodide  of 
Arsenic  and  Mercury. — Donovan's  solution.  Take  of  iodide  of  arsenic 
and  red  iodide  of  mercury  thirty-five  grains  each,  distilled  water  half  a 
pint.  Rub  the  iodides  in  half  an  ounce  of  water,  and  when  dissolved, 
add  the  remainder  of  the  water,  heat  to  the  boiling  point,  and  filter. 
This  preparation  has  been  found  very  useful  in  the  treatment  of  diseases 
of  the  skin,  and  will,  perhaps,  cure  a  larger  proportion  of  chronic  cases 
than  any  other  one  remedy.     Dose  from  five  to  ten  drops. 


ZINCDM. 

1.  Oxide  of  Zinc. — This  is  commonly  known  by  the  name  of  the 
floivers  of  zinc.  There  are  two  ways  in  which  this  may  be  prepared  : 
(a.)  By  the  combustion  of  metallic  zinc  in  a  crucible.  During  this  pro- 
cess it  unites  with  the  oxygen  of  the  atmosphere  and  is  sublimed. 
(6.)  By  adding  water  of  ammonia  to  a  solution  of  sulphate  of  zinc,  a 
precipitate  is  thrown  down,  which  is  to  be  separated  and  dried.  Here 
the  sulphuric  acid  unites  with  the  ammonia,  and  is  held  in  solution, 
while  the  oxide  of  zinc  is  precipitated. 

This  substance  is  a  white  powder,  without  taste  or  smell.  It  is  inso- 
luble both  in  water  and  in  alcohol. 

Effects. — The  oxide  of  zinc  possesses  tonic  properties,  but  its  powers 
in  this  way  are  comparatively  feeble.  As  a  remedy  in  epilepsy  and 
other  spasmodic  diseases,  it  was  first  introduced  into  practice  by  the 
celebrated  Gaubias,  and  from  the  high  authority  from  which  it  ema- 
nated, gained  considerable  celebrity,  which,  however,  it  has  not  since 
maintained. 

Mode  of  Administration. — The  best  form  of  giving  it  is  that  of  pill 
made  up  with  confection  of  red  roses,  in  doses  of  one  or  two  grains,  and 
gradually  increased. 

Copper. — There  are  only  two  preparations  of  this  metal  used  in 
medicine. 

1.  Sulphate  of  Copper. — This  salt  has  already  been  described  under 
the  head  of  emetics.  When  given  in  small  doses,  it  acts  without  pro- 
ducing any  sensible  local  effect,  as  a  general  tonic,   This  is  proved  by  the 


tonics.  489 

fact  that  it  is  capable  of  arresting  the  paroxysms  of  intermittent  fever. 

By  Dr.  Donald  Monro  it  was  prescribe]  in  1785,  in  sum'-  ca  es  of  this 
disease  with  success,  after  tbe  Peruvian  bark  and  other  medicines  bad 
been  administered,  without  any  benefit. 

Mode  of  Administration. — It  may  be  given  in  'loses  of  from  one 
fourth  of  a  grain  to  one  or  two  grains  made  into  pill  with  extra'),  of 
cinchona,  to  be  repeated  three  or  four  times  a  day. 

2.  Cuprum  Ammoniatum. — This  salt  is  prepared  by  rubbing  up  Bttl- 
phate  of  copper  with  carbonate  of  ammonia,  until  the  effervescence 
ceases.  It  is  then  to  be  wrapped  in  bibulous  paper  and  dried  with  a 
gentle  heat.  A  double  decomposition  here  takes  place.  Part  of  the 
sulphuric  acid  goes  to  the  ammonia,  forming  a  sulphate  of  ammonia, 
while  the  carbonic  acid  escapes  with  effervescence,  and  the  copper  re- 
mains in  a  state  of  sulphate.  The  compound  therefore  appears  to  be 
a  mixture  of  subsulphate  of  copper  and  sulphate  of  ammonia. 

As  found  in  the  shops  this  substance  is  a  violet-colored  mass,  with  an 
ammoniacal  smell  and  a  styptic  and  metallic  taste.  On  exposure  to  the 
atmosphere,  its  color  changes  to  green,  owing  to  the  escape  of  ammonia. 
It  is  soluble  in  water. 

Effects. — As  a  tonic  this  substance  operates  in  a  manner  similar  to 
the  sulphate  of  copper.  It  is  milder,  however,  and  therefore  may  be 
given  in  considerably  larger  doses.     Its  use  originated  with  Dr.  Cullen. 

Mode  of  Administration. — The  best  form  is  that  of  pill  made  up  with 
bread,  in  doses  of  half  a  grain  gradually  increased  to  five  grains,  two  or 
three  times  a  day. 

Nitric  Acid. — This  acid  is  obtained  by  decomposing  nitrate  of  potassa 
by  means  of  sulphuric  acid.  It  is  a  colorless  or  pale  yellow  fluid,  emit- 
ting, when  exposed  to  the  air,  white  suffocating  vapors  and  possessing 
strong  acid  properties.  It  is  highly  corrosive  and  tinges  the  skin  yellow, 
the  tint  remaining  till  the  epidermis  is  separated.  "When  exposed  to 
the  air  it  attracts  moisture  and  becomes  weaker.  It  unites  with  water 
in  every  proportion,  and  while  mixing,  heat  is  evolved.  In  its  pure  state, 
it  is  seldom  employed  except  for  pharmaceutical  purposes.  The  diluted 
acid  is  made  by  the  addition  of  six  fluid  ounces  of  water  to  one  of 
acid. 

In  its  effects  upon  the  system  nitric  acid  acts  as  a  general  and  efficient 
tonic.  It  is  particularly  valuable  when  the  constitution  has  been  broken 
down  during  a  long  protracted  course  of  mercurial  remedies.  In  these 
cases  it  not  merely  promotes  the  general  health,  but  it  also  lessens  the 
mercurial  action  upon  the  mouth  and  fauces.  In  chronic  hepatitis  and 
dropsy,  consequent  upon  a  shattered  constitution,  it  has  been  found  emi- 
nently serviceable. 

Besides  its  effects  as  a  general  tonic,  the  nitric  acid  produces  a  pecu- 
liar taste  in  the  mouth,  and  when  carried  to  a  certain  extent  some- 


490  MATERIA  MEDICA   AND   THERAPEUTICS. 

* 

times  brings  on  salivation,  and  at  the  same  time  acts  moderately  on  the 
bowels. 

Its  dose  is  from  20  to  30  drops,  given  in  §  iij  or  §  iv  of  water  three 
or  four  times  a  day. 

Besides  being  given  internally,  it  has  been  much  used  in  India  in  the 
form  of  a  bath  in  combination  with  muriatic  acid.  This  is  made  by 
taking  two  parts  of  muriatic  and  one  of  nitric  acid,  and  adding  water 
until  the  whole  is  about  as  sour  as  vinegar.  When  the  feet  are  put  in 
this  bath  it  is  remarkable  that  it  produces  the  same  effects  that  it  does 
when  taken  internally,  and  in  addition  to  this  causes  a  peculiar  excite- 
ment and  irritation  of  the  skin. 

The  nitro-muriatic  acid  bath  is  used  chiefly  in  syphilitic  cutaneous 
diseases  and  in  hepatic  affections.  It  was  formerly  very  popular,  but 
hardly  retains  its  reputation. 

Cotyledon   Umbilicus. 

[A  perennial  herbaceous  plant,  about  six  inches  high,  flowering  in 
June  and  July,  a  native  of  England,  found  in  dry  stony  places.  It  seems 
to  be  a  gentle  tonic  to  the  nervous  system,  and  has  been  chiefly  used  in 
epilepsy.  It  is  highly  recommended  by  Graves  of  Dublin,  and  others, 
but  the  trials  of  it  in  this  country  have  not  been  very  encouraging.  A 
fluid  and  a  dry  extract  are  used.  Dose  of  the  former  a  fluid  drachm,  of 
the  latter  five  grains,  to  be  increased  if  necessary.] 


ASTRINGENTS. 


The  term  astringent  is  applied  to  a  class  of  agents  which  possess  the 
power  of  corrugating  the  animal  fibre.  They  have  been  defined  to  be 
those  substances  which,  "  when  applied  to  the  human  body,  produce 
contraction  and  condensation  in  the  soft  solids,  and  therefore  increase 
their  density  and  force  of  cohesion."  This  definition  is  imperfect  only 
so  far  as  it  does  not  include  in  it  any  recognition  of  the  general  tonic 
influence  which  most  of  these  agents  exert  over  the  system. 

The  local  effects  of  astringents  are  obvious.  Wben  applied  exter- 
nally to  bleeding  vessels,  they  contract  the  vessels  and  arrest  the  bleed- 
ing ;  hence  called  styptics  ;  when  taken  into  the  mouth  they  have  a 
peculiar  and  rough  taste,  and  produce  a  sense  of  constriction  in  the 
parts  with  which  they  come  in  contact.  As  a  consequence  of  this  con- 
striction the  small  vessels  circulate  less  blood,  the  secretions  of  the 
mouth  and  fauces  are  lessened,  and  the  general  sensibility  of  these  parts 
to  other  impressions  temporarily  is  impaired.  When  swallowed  we 
infer  that  analogous  effects  are  produced  upon  the  mucous  membrane 
of  the  oesophagus,  stomach,  and  intestines  with  which  they  come  in 
contact.  At  the  same  time  that  they  act  upon  these  parts  by  constring- 
ing  them  and  lessening  expectoration  and  secretion,  they  also  affect 
their  vital  properties,  by  imparting  tone  to  them.  This  at  least  is  the 
case  with  a  great  proportion  of  them.  Accordingly,  if  given  in  mode- 
rate doses  like  tonics,  they  promote  the  appetite  and  assist  digestion. 
If,  on  the  other  hand,  they  be  given  in  very  large  doses,  they  disorder 
the  functions  of  digestion,  cause  pain,  and  not  unfrequently  produce 
nausea  and  vomiting. 

The  remote  effects  of  astringents  are  similar  in  character,  although 
less  in  degree  than  the  local  effects.  Various  portions  of  the  mucous 
tissue,  though  not  locally  acted  on,  nevertheless  participate  in  the  effects 
of  these  agents.  This  is  particularly  the  case  with  the  mucous  mem- 
brane lining  the  pulmonary  and  urinary  organs,  and  under  the  continued 
use  of  astringents,  exhalation  and  secretion  are  diminished  from  these 
parts. 

The  skin  is  strikingly  affected  in  a  similar  way.  In  the  ordinary 
condition  of  the  system  it  becomes,  under  the  use  of  astringents,  dry 

32 


492  MATERIA   MEDICA   AND   THERAPEUTICS. 

and  contracted ;  and  if  excessive  evacuations  take  place  they  are  re- 
strained. 

On  the  muscular  system  the  effect  of  astringents  is  analogous  to  that 
of  the  pure  tonics.  From  the  direct  impressions  made  hy  them  upon 
the  mucous  membrane  of  the  stomach  and  bowels,  the  muscular  tissue 
of  these,  organs  is  most  particularly  acted  on.  The  effect,  however, 
does  not  stop  here.  The  muscular  fibre  of  the  heart  and  arteries,  and 
indeed  of  every  other  part  of  the  system,  participates  more  or  less  in 
the  same  impression. 

On  the  vascular  system  the  effects  of  astringents  are  striking  and 
important.  In  consequence  of  the  contraction  which  they  produce  in 
the  small  vessels  of  the  part  to  which  they  are  applied,  together  with 
the  impaired  secretion  which  they  occasion,  the  blood  is  accumulated 
in  the  larger  trunks.  If  this  be  continued  for  any  length  of  time,  the 
heart  and  bloodvessels  become  crowded,  reaction  now  takes  place,  the 
pulse  is  full  and  hard,  general  plethora  ensues,  and  as  remote  conse- 
quences, local  congestions  and  hemorrhages  may  occur. 

On  the  brain  and  nervous  system  astringents  produce  no  direct  effect, 
except  from  the  properties  which  they  possess  in  common  with  tonics. 
In  this  way  they  increase  the  energy  of  the  nervous  system.  Indirectly, 
however,  as  pure  astringents  they  may  exert  a  powerful  agency  on  this 
part  of  the  system.  By  checking  the  secretions  they  produce  general 
plethora  and  local  determination  to  the  brain,  which  not  unfrequently  is 
followed  by  cerebral  congestion  and  paralysis. 

With  regard  to  the  manner  in  which  the  remote  effects  of  astringents 
are  brought  about,  whether  by  the  actual  introduction  of  these  agents 
into  the  circulation,  or  by  the  mere  transmission  of  the  local  impres- 
sions, it  is  impossible  to  say.  In  some  cases,  doubtless,  it  may  be  in  the 
first  of  these  modes  ;  in  the  majority,  it  is  probably  in  the  latter.  Be 
this  as  it  may,  that  various  parts  of  the  animal  economy  are  thus  more 
or  less  influenced  is  certain. 

From  the  preceding  analysis  of  the  effects  of  astringents,  it  is  very 
evident  that  they  cannot  be  used  with  safety  or  advantage  in  every  state 
of  the  system  ;  they  ought  not  to  be  used  where  a  general  plethora 
exists.  In  such  a  state,  if  by  the  use  of  astringents  the  ordinary  secre- 
tions be  checked,  the  general  fulness  of  the  bloodvessels  must  be  in- 
creased, and  apoplexy  or  some  analogous  effect  may  be  produced.  So, 
also,  when  a  discharge  is  taking  place  from  the  system  in  a  full  habit, 
such  as  diarrhoea  or  hemorrhoids,  or  the  like ;  if  this  be  arrested  by  the 
use  of  astringents,  the  consequence  must  be  injurious,  and  sometimes 
fatal.  In  these  cases  nature  is  endeavoring  to  relieve  herself  from  over- 
fulness  by  a  critical  evacuation,  and  any  interference  with  this  may  be 
hazardous. 

They  ought  not  to  be   prescribed  where    febrile   or  inflammatory 


ANTRINl.KMS.  493 

excitement  is  present,  Tn  fevers  and  inflammations  one  of  the  great 
objects  is  to  relax  the  whole  system  of  capillary  vessels,  or  in  other 
words,  to  promote  till  the  secretions,  and  generally  just  in  proportion  as 
this  object  is  accomplished  will   the  excitement  be  lessened.     On  the 

contrary,  astringents  checking  the  secretions  necessarily  increase  the 
existing  excitement,  and  frequently  cause  local  obstructions. 

They  ought  not  to  be  prescribed  where  excessive  secretion  depends 
upon,  or  is  associated  with,  active  irritation  either  local  or  general.  To 
this  rule  exceptions,  however,  exist,  which  will  be  mentioned  hereafter. 

They  ought  not,  as  a  general  rule,  to  be  prescribed  where  there  is 
much  disorder  of  the  digestive  organs,  as  indicated  by  furred  tongue, 
defective  secretion  of  bile,  costive  bowels,  <fcc.  In  all  cases  this  should 
first  be  corrected  by  appropriate  remedies.  Otherwise,  not  merely  will 
astringents  fail  in  producing  their  intended  effect,  but  the  disorder  of  the 
digestive  organs  will  be  aggravated. 

There  are  various  modes  in  which  astringents  may  be  made  to  act  on 
the  system   : 

1.  By  applying  them  directly  to  the  part  which  it  is  desired  to  con- 
stringe.  In  this  way  they  may  be  used  as  injections  to  many  parts  of 
the  system,  as  the  eye,  the  ear,  the  fauces,  the  urethra,  the  rectum,  Arc. 
This  is  the  most  efficient  mode  of  producing  the  intended  effect. 

2.  By  taking  them  into  the  stomach.  In  this  way  they  act  not 
merely  on  the  parts  to  which  they  are  immediately  applied,  but  they 
extend  their  influence  to  distant  parts. 

3.  By  applying  them  to  the  skin — cold,  applied  either  to  the  whole 
surface  in  the  shape  of  cold  baths,  or  local  applications  of  cold  water 
and  ice,  extends  its  astringent  influence  to  the  internal  parts  of  the  body. 

4.  By  injections  into  the  rectum.  In  this  way  they  not  merely  affect 
the  rectum  itself  but  extend  their  influence  to  other  parts.  Hence,  in 
uterine  hemorrhage,  one  of  the  most  efficient  agents  is  the  injection  of 
cold  water  into  the  rectum. 

[The  quantity  of  fluid  should  be  large. — Ed.] 

From  what  has  been  already  stated  concerning  the  effects  of  these 
agents  upon  the  system,  it  is  evident  that  their  therapeutical  agency 
must  be  mainly  limited  to  the  accomplishment  of  two  objects: 

1.  To  the  restraining  of  excessive  evacuations  from  the  system 
whether  in  the  form  of  blood  or  various  secreted  fluids. 

2.  To  the  producing  contractions  of  relaxed  animal  fibre,  and  thus 
imparting  tone.  It  is  with  a  view  to  these  effects  that  they  are  used  in 
various  diseases.  In  those  affections  which  are  characterized  by  increased 
secretions  of  various  kinds,  these  secretions  take  place  from  different 
textures  and  different  organs,  and  the  effects  of  astringents  will  of  course 
differ  accordingly.  Over  the  secretions  from  some  textures  they  exer- 
cise a  very  marked  control,  over  those  from  others  very  little. 


494  MATERIA   MEDICA    AND   THERAPEUTICS, 

Of  Mucous  Membranes. — This  membrane  throughout  its  whole  extent 
is  liable  to  discharges,  constituting  a  very  large  and  exceedingly  trouble- 
some set  of  affections.  They  result  from  different  causes  ;  in  some  cases 
from  actual  inflammation,  in  others  from  irritating  and  enfeebling  causes. 
In  both  cases  the  effect  is  the  same — an  increased  discharge  from  the  part. 
From  what  has  already  been  stated  in  relation  to  the  effects  of  astringents, 
it  is  very  evident  that  unless  used  with  great  discretion,  they  will  not  mere- 
ly fail  of  producing  their  intended  effect,  but  will  be  positively  injurious. 
As  a  general  rule,  the  only  condition  of  the  system,  and  of  the  part 
affected,  in  which  they  can  be  used  with  safety  and  advantage,  is  that 
in  which  the  discharge  is  of  a  purely  passive  character,  or  in  other  words 
where  all  local  inflammation  and  general  excitement  have  been  previ- 
ously subdued.  If  used  antecedently  to  this  their  necessary  effect  must 
be  to  augment  the  distension  of  the  vessels  concerned,  and  thus  aggra- 
vate the  inflammation. 

[This  is  the  general  rule,  and  may,  with  very  slight  variations,  be 
applied  to  all  the  different  mucous  membranes,  and  thus  guide  us  in  the 
use  of  collyria,  of  gargles,  of  injections,  and  of  astringents  taken  into 
the  stomach  to  control  excessive  discharges  from  the  alimentary  canal. 
In  all  these  cases,  if  the  astringent  is  used  while  yet  acute  or  sub-acute 
inflammation  is  present,  it  is  sure  to  do  harm.  It  is  only  when  this  has 
been  subdued,  and  when  a  passive  congestion  or  a  mere  relaxation  of 
the  membrane  is  present,  that  astringents  are  proper.  No  one  now  doubts 
but  that  leucorrhcea  gained  its  character  of  a  most  intractable  disease 
mainly  from  the  indiscriminate  use,  or  rather  abuse,  of  astringent  vaginal 
injections. — Ed.] 

The  second  form  of  excessive  evacuation,  to  restrain  which  we  use 
astringents,  is  haemorrhage.  These  discharges,  whether  from  the  lungs, 
the  bowels,,  or  the  uterus,'  are  all  more  or  less  under  the  influence  of 
astringents  judiciously  applied.  To  get,  however,  a  good  effect  from 
them,  they  must  be  used  with  due  regard  to  the  cause  of  the  discharge 
and  the  state  of  the  system.  As  a  general  rnle  it  is  just  in  proportion 
as  the  haemorrhage  is  more  or  less  markedly  passive  that  a  good  effect 
may  be  expected  from  astringents. 

The  other  class  of  affections  in  which  astringents  are  used  is  where 
the  object  is  to  produce  a  constringing  and  then  a  tonic  impression  on 
the  relaxed  parts.  The  good  effect  of  astringents  in  passive  diarrhoea 
is  to  be  explained  in  this  way.  The  surgeons  have  made  an  ingenious 
application  of  astringents  in  the  treatment  of  reducible  hernia.  Mr. 
Lizars  applied  a  very  strong  decoction  of  oak  bark  to  the  groin  over  a 
hernial  tumor,  the  hernia  having  been  reduced,  and  by  long-continued 
use  the  skin  and  subjacent  parts  were  so  constringed  as  to  prevent  the 
hernia  from  coming  dowm 


ASTRINGENTS.  495 

1NDIVI  D  CJ  A  L     A  S  TR I K  Q  E  N  T  S . 

Tannin,  or  Tannic  Acjd. — This  is  a  peculiar  substance  existing  in 
astringent  vegetables  generally,  and  is  the  chief  cause  of  the  astringency 
of  vegetable  matter.  It  is  frequently  associated  with  gallic  acid,  as  in 
gallnuts,  in  most  kinds  of  baric,  and  in  tea;  but  in  kino,  catechu  and 
cinchona  little  gallic  acid  is  present. 

("Chemists  recognise  two  kinds  of  tannic  acid;  one  from  galls  which 
produces  a  bluish  black  precipitate  with  the  sesqui  salts  of  iron,  the  other 
from  catechu,  cinchona,  <fcc,  a  greenish  black.  The  former  is  very  rea- 
dily converted  into  gallic  acid,  and  is  called  by  some  gallo-tannic  acid  ; 
it  is  the  substance  ordinarily  described  as  Tannic  acid.] 

It  may  be  obtained  in  an  impure  state,  by  digesting  bruised  gallnuts, 
oak  bark,  &c,  in  a  small  quantity  of  cold  water  and  evaporating  the 
solution. 

Thus  obtained  it  is  in  the  form  of  powder;  yellowish  white;  no  smell; 
taste  purely  astringent,  without  bitterness. 

Effects. — Tannin  is  a  pure  and  powerful  astringent,  and  may  be  given 
in  all  the  cases  where  such  an  agency  is  required.  It  has  been  used  in 
diarrhoea,  dysentery,  fluor  albus,  in  haemorrhages,  and  in  chronic  catarrh, 
It  has  some  reputation  as  a  stomachic.  A  grain  twice  a  day  is  said  to 
increase  the  appetite. 

Dose. —  ltg_4^grs.  every  four  hours,  or  oftener. 

Gall^e. — Gallnuts. — These  are  excrescences  produced  on  the  branches 
of  the  quercus  infectoria,  a  species  of  oak  growing  in  Asia  Minor,  five  or 
six  feet  high.  The  cynijis  gallw  tinctorice  punctures  the  young  branches 
of  the  tree  and  there  deposits  its  egg.  A  morbid  irritation  ensues.  In  a 
few  hours  an  excrescence  is  formed,  and  in  a  day  or  two  attains  its  full 
size.  This  is  the  gall.  Within  this  the  insect  undergoes  its  various 
changes;  the  egg  is  hatched;  and  the  larva,  feeding  upon  the  interior 
of  the  gall,  makes  a  hole  in  it.  Finally  it  changes  into  the  state  of  fly 
and  then  eats  its  way  out.  Galls  are  found  in  the  market  in  two  different 
states,  according  as  they  are  gathered  before  or  after  the  insect  escapes. 
The  black,  blue,  or  green  galls,  gathered  before  it  escapes;  the  white 
galls  after.  [The  gall  is  sometimes  produced  by  the  plant  lice  or  aphi- 
dians.] 

Gallnuts  are  nearly  round ;  in  size  from  a  pea  to  a  hazelnut,  with 
small  tuberosities  on  their  surface.  The  best  are  the  blacl:,  blue,  and 
green  galls.  They  have  no  external  opening;  are  heavy,  compact,  and 
brittle,  and  break  with  a  resinous  fracture.  Internally  of  a  whitish  color, 
with  a  small  hole  in  the  centre.  The  white  are  inferior,  have  a  loose 
texture,  break  with  a  powdery  appearance,  and  have  a  large  cavity  in 
the  centre  communicating  external!}'.  These  contain  much  less  astrin- 
gent matter — powder  greyish. 


496  MATERIA  MEDICA  ANT>  THERAPEUTICS. 

Galls  have  no  smell,  but  a  bitter,  astringent  taste.  Best  galls  are 
from  Aleppo. 

Composition. —  Tannic  acid,  gallic  acid,  a  peculiar  volatile  oil,  and  a 
peculiar  acid  discovered  by  Braconnet,  and  called  by  him  Ellagic  acid. 
The  proportion  of  tannin  in  galls  is  greater  than  in  any  other  known 
substance.-  As  analysed  by  Sir  Humphrey  Davy,  100  parts  contained 
37  parts  soluble  in  water  and  63  parts  insoluble  (lignin).  Of  the  solu- 
ble parts  26  were  tannic  acid  ;  6.2  gallic  acid  ;  with  a  little  extractive  ; 
2.4  mucilage,  and  2.4  saline  or  earthy  matters. 

Galls  give  up  their  active  principle  to  water,  alcohol,  and  alkalies. 

Incompatibles. — Metallic  salts  which  throw  down  tanno-gallates.  Isin- 
glass throws  down  tannate  of  gelatine.  Infusion  of  cinchona,  tannutes  of 
cinckonine  and  quinine.  Infusion  of  opium,  tannates  of  morphine  and 
codeia. 

Effects. — One  of  the  most  powerful  astringents  we  possess.  From  its 
bitterness  not  much  used  internally. 

Forms. — Powder. — Dose. — 10  to  20  grs. 

Infusion. —  §  ss  to   §  j. 

Tincture. —  3  ss  "to  3  j ;  used  principally  diluted  with  water  as  an  astrin- 
gent wash  or  gargle. 

Ointment. —  3  j  to   3  vij  of  lard. 

Ung.  Gallce  Compositum. — Galls  finely  powdered,  3  ij ;  opium  pow- 
dered, 3  ss ;  lard  3  ij,  M.,  an  excellent  application  to  piles  when  not  very 
much  inflamed. 

Besides  being  used  as  a  simple  astringent,  galls  in  the  form  of  infusion 
are  used  as  an  antidote  in  cases  of  poisoning  by  the  organic  alkalies  and 
those  vegetables  which  contain  them,  such  as  mix  vomica,  hellebore, 
opium,  &c.  They  form  in  these  cases  a  tannate  with  the  alkali,  which 
has  less  activity  than  the  alkali,  because  probably  less  soluble.  Also  in 
cases  of  poisoning  by  tartar  emetic. — Pereira. 


CATECHU. 

This  substance  is  obtained  from  the  Acacia  catechuT  a  tree  twelve  or 
fourteen  feet  high,  growing  abundantly  in  the  mountains  of  Hindostan. 
It  is  an  extract  obtained  from  the  wood.  The  exterior  white  part  of  the 
wood  is  first  cut  off,  and  then  the  interior,  which  is  reddish  brown,  cut 
into  small  chips,  is  boiled  in  water  until  all  the  soluble  matter  is  dis- 
solved. The  decoction  is  then  poured  off  and  evaporated,  until  it 
becomes  of  a  certain  consistence,  when  it  is  spread  upon  cloth,  cut  into 
small  pieces,  and  suffered  to  dry.  This  is  the  catechu  of  medicine.  It 
cbmes  in  masses  of  different  shapes  and  sizes,  sometimes  in  square  cakes, 
at  others  in  roundish  or  irregular  masses.     The  color  varies  from  a  red- 


AKTIHNOICNTS.  497 

dish  brown  to  a  deep  chocolate  or  liver  color,  lis  texture  is  brittle; 
fracture  sometimes  rough,  at  others  resinous  ;  no  smell  ;  taste  bitter  and 
astringent,  leaving  behind  a  sensation  of  sweetness. 

There  are  a  great  many  varieties  of  this  article;  they  arc  all,  however, 
the  same  substance,  differing  only  in  the  mode  of  preparation. 
Catechu  is  almost  entirely  dissolved  by  water  and  by  alcohol. 
Composition. —  Tannic  acid,  a  peculiar  extractive  mucilage.      In    1833 
a  peculiar  substance  was  discovered  in  it,  which  was  called  catechine 
(catechinic  acid). 

According  to  the  analysis  of  Sir  II.  Davy  the  proportions  of  ingredi- 
ents were  the  following  : 

Bombay  Catechu.  Bengal  Catechu. 

Tannin,  .         .         .     54.5         .         .         48.5 

Peculiar  extract,      .         .     34.0         .         .         3G.5 
Mucilage,         ...        6.5  .  .  8.0 

Insoluble  impurities  )  _  ~  *  A 

(lime  and  sand),    j 


100.0  100.0 

All  the  varieties  of  catechu  are  adulterated  with  sand,  starch,  and 

other  impurities. 

Effects. — One  of  the  best  and  most  powerful  astringents,  and  slightly 

tonic. 

Forms  of  Administration. — The  solid  lump  is  allowed  to  dissolve  in 

the  mouth.     This  is  better  than  the  catechu  lozenges.     Powder. — Dose 

grs.  x  to  xx.    Infusion. — Catechu  3  vj,  cinnamon  3  i,  water  a  pint.    Dose 
|j  to    |  ij.     Tincture. — Dose    3i — a  very  pleasant  addition  to  chalk 

mixtures. 


The  inspissated  juice  of  the  Pterocarpus  marsupium,  and  other 
plants.  IT.  S.  The  best  kind  is  the  East  Indian,  from  the  P.  mar- 
supium, a  lofty  tree  growing  in  the  mountains  of  Hindostan.  It  comes 
to  us  in  small  angular  shining  fragments  of  a  deep  brown  or  reddish 
color ;  opaque,  hard,  and  brittle.  In  the  mouth  it  softens,  sticks  to  the 
teeth,  and  colors  the  saliva  red  ;  has  no  smell ;  an  astringent,  followed 
by  a  sweetish  taste — easily  pulverized. 

Its  best  menstruum  is  diluted  alcohol. 

Composition. —  Tannic  acid  and  peculiar  extractive  75,  red  gum  24-, 
insoluble  matter  1.     Recently  catechine  has  been  discovered  in  it. 

Incompatible s. — The  same  as  galls. 

Efects. — Astringent,  without  any  tonic  power — inferior  to  catechu. 

Forms. — Powder,  x  to  xxx_grs.     Infusion,   3  i  to   5  ij.     Tincture,  3  i 


498  MATERIA   MEDICA   AND   THERAPEUTICS. 

to   3  ij-     Locally,  in  powder,  to  flabby  ulcers,  and  as  a  gargle,  injection, 
and  wash. 

OAK    BARK. 

The  species  of  oak  from  which  this  is  obtained  in  Europe  is  the 
Quercus  pedunculata,  or  the  Quercus  robur,  growing  in  England  and 
all  over  tbe  continent.  In  this  country  it  is  obtained  from  the  Quercus 
alba,  a  species  of  oak  very  analogous  to  the  English  oak.  It  grows  in 
every  part  of  the  Union,  but  abounds  most  in  the  middle  states — so 
called  from  the  white  color  of  the  bark. 

Oak  bark,  deprived  of  its  epidermis,  is  of  a  light  brown  color;  coarse 
fibrous  texture,  and  not  readily  pulverized ;  has  a  feeble  odor,  and  a 
rough,  astringent,  bitterish  taste.  Water  and  alcohol  both  extract  its 
virtues. 

Composition. —  Tannic  acid,  gallic  acid,  tannates  of  lime,  magnesia, 
and  potash,  uncrystallizable  sugar,  pectin,  and  lignin. — Pereira. 

The  proportion  of  tannic  acid  in  the  bark  varies  with  the  size  and  age 
of  the  tree,  and  the  season  of  the  year  when  gathered.  The  young  bark 
contains  the  most ;  and  according  to  Sir  H.  Davy,  the  bark  collected  in 
the  spring  contain  four  times  the  quantity  of  that  gathered  in  the  winter. 

The  inner  part  of  the  bark  contains  the  greatest  proportion  of  tannin, 
the  circular  or  middle  portion  less,  while  the  epidermis  contains  none 
at  all. 

Effects. — Astringent  and  somewhat  tonic. 

Administration. — Powder,   3  ss  to   3  i. 

Decoction,  §  i  to  3  ij.  Principally  used  as  a  local  application — gargle 
— injection.     [I  have  cured  chronic  eczema  with  it.] 

Statice  Caroliniana  [Marsh  Rosemary). — A  small  maritime  plant 
indigenous  in  this  country,  from  six  to  twelve  or  more  inches  in  height ; 
grows  in  the  salt  marshes  along  the  sea  coast  from  Maine  to  Florida. 
The  part  used  is  the  root:  this  is  large,  spindle-shaped,  fleshy,  rough, 
and  of  a  purplish  brown  color.  No  smell ;  taste  bitter  and  astringent. 
Water  extracts  its  virtues. 

Composition. — Tannic  acid,  gallic  acid,  extractive  matter,  and  some 
common  salt. 

Effects. — Powerfully  astringent. 

Forms. — Decoction. — Boiling  3  ij  in  3  xii  of  water  ;  usedj  internally 
and  externally. 

The  decoction  of  marsh  rosemary  is  much  used  as  a  gargle  in  the 
different  varieties  of  sore  mouth,  venereal  sore  throat,  cynanche  ma- 
ligna, &c.  In  the  second  stage  of  diarrhoea  it  has  great  reputation  in 
some  parts  of  the  country. 


ASTRINGENTS.  10'J 


geranium  maculatum  [Spotted  geranium,  Croups  foot,  Crane's  bill). 

A  perennial  plant  from  one  to  two  or  three  feet  high,  growing  in 
every  part  of  the  United  States  in  low  grounds  and  damp  woods.  The 
part  used  is  the  rhizome,  which  is  taken  up  in  the  autumn  and  dried; 

comes  in  pieces  two  or  three  inches  long,  and  one-third  to  half-an-inch 
thick;  externally,  rough  and  dark  brown ;  internally,  pale  flesh  color; 

has  no  smell;  taste  astringent,  hut  not  hitter  or  unpleasant;  if  properly 
dried  brittle  and  easily  reduced  to  powder.  Its  virtues  extracted  both 
by  water  and  alcohol. 

Composition. —  Gallic  acid  in  large  quantity,  tannic  acid,  small  quan- 
tity of  mucilage,  starch,  red  coloring  matter,  resin,  a  small  quantity,  and 
a  crystallizable  vegetable  substance. 

Effects, — An  excellent  astringent  of  considerable  power;  has  the 
advantage  over  many  other  articles  in  this  pleasant  taste.  Hence  a 
good  article  for  children  and  delicate  stomachs. 

Administration. — Powder. — Dose  twenty  to  thirty  grains. 

Decoction. —  3  i  of  bruised  root  boiled  a  few  minutes  in  a  pint  of 
water  or  milk.     Dose   §  i  to   3  ij.     [An  excellent  article  for  children.] 

Tincture. — Dose  3  i  to   3  ij. 


ACETAS    PLUMBI. 

This  salt  is  known  by  the  common  name  of  the  Sugar  of  Lead,  and 
is  generally  prepared  by  the  manufacturer  on  a  large  scale. 

Physical  Properties. — Sugar  of  lead  is  a  white  crystalline  salt  with- 
out smell ;  its  taste  is  sweetish  and  astringent.  When  exposed  to  the 
atmosphere  it  slightly  effloresces ;  soluble  both  in  -water  and  alcohol ; 
water  at  60°  dissolving  four  times  its  weight. 

Chemical  Composition. — One  eq.  of  acetic  acid,  51 ;  one  of  prot.  of 
lead,  112;  and  three  of  water,  27  =  190. 

Test  of  its  Purity. — Dissolved  in  distilled  water  free  from  carbonic 
acid,  if  pure,  it  makes  a  perfect  solution.  To  ascertain  this,  sulphuric 
acid,  or  sulphuretted  hydrogen  in  excess,  being  added  to  the  solution  to 
throw  down  the  lead,  the  supernatant  liquid  should  be  completely  vola- 
tilized by  heat;  any  fixed  residue  is  impurity.     (Pereira,  vol.  i.  p.  516.) 

Incompatibles. — "  All  those  acids  and  their  compounds  which  form 
with  oxide  of  lead  salts  nearly  insoluble  in  water,  as  the  sulphuric, 
muriatic,  carbonic,  citric,  and  tartaric.  It  is  decomposed  by  lime  water, 
by  the  alkalies,  ammonia,  potash,  and  soda ;  the  two  latter,  if  added  in 
excess,  redissolve  the  precipitate  at  first  formed.  Hard  water  usually 
contains  three  ingredients  which  decompose  it,  viz.  carbonate  of  lime, 


500  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

sulphate  of  lime,  and  muriate  of  soda;  and  hence,  when  dissolved  in 
such  water,  the  solution  is  always  turbid.  It  is  decomposed  by  solution 
of  sulphuretted  hydrogen,  which  gives  a  black  sulphuret;  liquor  ammo- 
nite acetatis  also  decomposes  it,  on  account  of  the  carbonic  acid  diffused 
through  it."     (Phillips,  p.  127.) 

Effects. — Sugar  of  lead  acts  as  an  astringent  to  the  part  with  which 
it  comes  in  contact,  whether  taken  internally  or  applied  externally,  by 
coagulating  the  albumen  of  the  tissues  and  forming  an  insoluble  com- 
pound. Taken  internally  in  moderate  doses,  its  immediate  effect  is  to 
constringe  the  vessels  of  the  mucous  membrane  of  the  alimentary  canal, 
and  so  lessen  secretion  from  them.  Hence  costiveness  is  one  of  its 
immediate  effects.  If  its  use  be  continued,  the  same  astringent  effect  is 
extended  to  other  parts  of  the  system.  This  is  especially  manifested  in 
the  mucous  membrane,  the  skin,  and  the  urinary  organs,  in  all  of  which 
the  secretions  are  lessened.  In  addition  to  this  the  temperature  of  the 
body  is  diminished,  and  the  pulse  is  lessened  in  force  and  frequency. 
In  its  general  operation,  therefore,  it  acts  as  an  astringent  and  a  sedative. 

If  the  use  of  it  be  persisted  in  too  long,  it  produces,  in  common  with 
the  other  preparations  of  lead,  certain  striking  effects  on  the  nervous 
and  muscular  systems;  one  of  these  is  a  form  of  colic,  called  the  paint- 
er's colic  ;  the  other  is  a  peculiar  kind  of  paralysis. 

If  a  large  dose  of  the  sugar  of  lead  be  taken  at  once,  it  acts  as  an 
irritant  poison. 

Mode  of  Administration. — The  ordinary  mode  of  giving  sugar  of  lead 
is  in  pill,  in  doses  of  one  or  two  grains,  repeated  every  two,  three,  or 
four  hours,  according  to  circumstances.  Most  generally  it  is  given  in 
combination  with  opium. 

Solution. —  3  ij  to  a  pint  of  water. 

Diseases  in  which  used. — Haemorrhages,  excessive  secretion  from  the 
mucous  membranes,  cholera,  diarrhoea,  chronic  dysentery,  night  sweats. 

Goulard's  Extract. — This  is  the  liquor  plumbi  subacetatis,  or  the 
solution  of  the  subacetate  of  lead.  It  is  called  Goulard's  Extract,  from 
M.  Goulard,  a  surgeon  of  Montpelier,  by  whom  it  was  more  especially 
introduced  into  notice. 

According  to  the  United  States  Pharmacopoeia,  this  is  prepared  by 
taking  of  the  acetate  of  lead  and  of  the  semi-vitrified  oxide  of  lead 
(litharge)  each  eight  ounces,  mixed  in  a  glass  vessel,  and  boiling  for 
twenty  minutes  in  two  pints  of  distilled  water,  then  filtering  through 
paper.  During  this  process  the  protoxide  is  dissolved  and  a  subacetate 
is  formed,  which  is  held  in  solution. 

Properties. — Goulard's  Extract  is  either  transparent  or  colorless,  or  it 
has  a  slight  greenish  yellow  tint,  arising  from  impurities  in  the  distilled 
vinegar  :  its  taste  is  sweetish  and  astringent.     It  is  readily  decomposed. 


ASTRINGENTS.  501 

Common  s^rjnjrj^ter  throws  down  tin;  oxide  of  lead  in  large  quan- 
titi<;s.  Carbonic  acid  tb'rowe  drown  the  carbonate  of  lead.  Tliis  bap- 
pens  iV< lere  exposure  to  the  atmosphere.     Even  distilled  water,  if 

exposed  to  the  atmosphere,  produces  the  same  effect,  by  the  carbonic 
acid  which  it  contains. 

From  the  effect  of  carbonic  acid  on  it,  it  should  always  be  kept  in 
tight  bottles. 

Effects  and  Uses. — This  is  only  used  externally  as  a  local  application, 
and  its  effect  is  analogous  to  that  of  the  solution  of  sugar  of  lead.  It 
acts  as  a  local  astringent  and  sedative  in  cases  of  local  inflammation. 

When  used  it  requires  to  be  diluted;  about  four  drachms  require  a 
pint  of  water  to  be  added.  It  is  an  excellent  application  to  piles  where 
there  is  little  inflammation. 


This  is  a  triple  salt  consisting  of  alumina,  potash,  and  sulphuric  acid. 
In  some  places  it  is  found  native,  effloresced  on  the  soil  in  volcanic 
regions.  This  is  the  case  near  Naples.  The  alum  "is  collected  and 
lixiviated,  and  the  solution  made  to  crystallize  by  slow  evaporation  in 
leaden  vessels  sunk  in  the  ground." — TJ.  S.  Disp. 

Most  commonly,  however,  it  is  obtained  from'  the  alum  ores.  It  is 
also  manufactured  by  a  direct  combination  of  its  constituents.  This  is 
the  mode  in  this  country,  where  all  the  alum  for  domestic  purposes  is 
now  prepared. 

Properties. — Alum  is  a  white  crystalline  salt,  with  a  sweetish,  acidu- 
lous, astringent  taste,  without  smell.  On  exposure  to  the  atmosphere  it 
slightly  effloresces,  its  solution  reddens  litmus  paper,  "but  changes  the 
blue  tinctures  from  the  petals  of  plants  green.  It  cannot,  therefore,  be 
properly  said  to  contain  an  excess  of  acid." — (TJ.  S.  Disp.)  Alum  is 
soluble  in  15  times  its  weight  of  cold  water,  and  three  fourths  of  its 
weight  of  boiling  water.  Alum  contains  a  large  proportion  of  water  of 
crystallization,  amounting  to  nearly  50  parts  in  100.  By  exposure  to 
beat  it  undergoes  watery  fusion.  By  increasing  the  heat  the  alum 
swells,  the  water  is  driven  off,  and  it  becomes  a  white,  friable,  spongy 
mass.  This  is  called  Alumen  exsiccatum,  dried  alum,  or  Alumen  ustum, 
burnt  alum. 

Effects. — Alum  is  one  of  the  most  powerful  astringents  that  we 
possess.  When  first  taken  internally,  if  the  stomach  be  at  all  delicate 
or  irritable,  it  is  apt  to  cause  gastric  uneasiness,  nausea,  and  sometimes 
vomiting.  To  a  certain  extent  this  may  be  obviated  by  combining  it 
with  some  aromatic.  The  best  plan  is  to  begin  with  small  doses,  and 
to  increase  gradually  as  the  stomach  is  found  to  bear  it.    On  the  bowels 


502  MATERIA   MEDICA   AND   THERAPEUTICS. 

the  general  effect  is  to  produce  constipation.  In  large  doses,  however, 
it,  on  the  contrary,  causes  irritation,  griping,  and  purging. 

In  its  general  operation  on  the  system  alum  proves  stimulant.  Its 
use,  therefore,  should  be  limited  to  those  cases  in  which  a  stimulant 
astringent  is  required. 

Burnt  alum  differs  from  common  alum  only  in  not  having  any  water 
of  crystallization.     It  is  more  astringent. 

Forms  of  Administration. — Substance. — It  may  be  taken  in  powder 
or  pills  made  up  with  some  tonic  or  aromatic,  in  doses  of  from  five  to 
ten  grains. 

Alum  Whey. — This  is  made  by  boiling  3  ij  of  alum  with  a  pint  of 
milk,  and  then  straining.  Of  this  a  wineglassful  at  a  time  may  be 
taken.     This  is  a  very  pleasant  and  good  way  of  administering  alum. 

As  a  Local  Application.  Powder. — The  burnt  alum  is  applied  to 
indolent  ulcers  to  destroy  spongy  granulations. 

Solution. — As  a  gargle,  collyrium,  and  injection. 

Plug. — A  solid  stick  of  alum  cut  round,  introduced  into  the  vagina 
in  cases  of  haemorrhage  from  uterus. 

[  Vaginal  Injection. — A  very  weak  solution  of  alum  will  suit  a  larger 
number  of  cases  of  vaginal  relaxation  and  free  secretion  than  any  other 
astringent  I  know  of.  It  should  be  very  weak — my  rule  is  to  make  it 
just  strong  enough  to  taste  of  alum. — Ed.] 


SULPHURIC     ACID. 

In  its  pure  state,  sulphuric  acid  is  not  used  in  medicine.  In  a  state 
of  dilution  there  are  two  preparations  which  are  officinal : 

1.  The  Acidum  Sulphuricum  Dilutum. — This  is  prepared  by  adding 
gradually,  and  then  mixing,  one  fluid  ounce  of  sulphuric  acid  with 
thirteen  fluid  ounces  of  water. 

2.  Acidum  Sulphuricum  Aromaticum. — This  is  known  by  the  com- 
mon name  of  the  Elixir  of  Vitriol.  It  is  prepared  by  digesting  for 
three  days  in  a  close  vessel  three  ounces  and  a  half  of  sulphuric  acid 
with  two  pints  of  alcohol,  then  adding  bruised  ginger  one  ounce,  and 
cinnamon  bruised  one  ounce  and  a  half,  and  letting  the  whole  macerate 
for  a  week,  and  then  filtering.  This  forms  a  dark  brown  liquid,  having 
an  acid  taste  and  peculiar  aromatic  odor.  Both  these  preparations  of 
sulphuric  acid  are  taken  in  the  same  doses  and  in  the  same  way.  From 
ten  to  thirty  drops,  in  a  cup  of  cold  water,  may  be  repeated  three  or 
four  times  a  day. 

Effects. — In  the  two  preceding  forms,  sulphuric  acid  is  astringent, 
refrigerant,  and  tonic.  It  gives  tone  to  the  digestive  organs,  improves 
the  appetite,  and  checks  excessive  secretion.     Over  the  skin  it  exerts  a 


ASTEINGEimS-  503 

peculiar  agency,  checking  profuse  sweating  more,  effectually,  perhaps, 
than  any  other  astringent.  On  the  urinary  organe  its  effeel  is  to 
increase  the  secretion  of  the  urine,  ami  to  render  it,  acid.  Cinder  its 
use  the  milk  frequently  acquires  a  griping  quality. 

If  the  use  of  this  acid  be  continued  too  long,  it  produces  a  slow  irri- 
tation of  all  the  digestive  organs,  heat  and  pain  in  the  stomach,  griping, 
purging,  and  general  constitutional  irritation. 

In  its  pure  state  it  acts  as  an  irritant  poison. 

ACKTIC    ACID. 

It  is  only  in  its  impure  state,  or  that  of  vinegar,  that  this  acid  is  used 
internally. 

Effects. — Vinegar  is  astringent,  refrigerant,  and  tonic.  Taken  in  mo- 
derate quantities  it  gives  tone  to  the  digestive  organs,  and  increases  the 
appetite.  In  its  general  action,  it  lessens  the  heat  of  the  system,  checks 
secretion,  and  gives  tone.  If  taken  in  too  large  quantities  it  irritates 
the  digestive  organs,  causing  pain  and  griping,  and  if  persisted  in,  pro- 
duces general  emaciation.  On  this  account  it  is  frequently  given  to 
correct  too  great  obesity. 

Mode  of  Administration. — One  or  two  ounces  may  be  added  to  a 
quart  of  water  and  drunk  freely. 

Matico. — This  remedy  was  brought  to  the  notice  of  the  profession  in 
the  United  States  by  Dr.  Kuschenberger,  IT.  S.  N.,  who  obtained  a 
knowledge  of  it  in  South  America.  It  consists  of  the  leaves  and  unripe 
fruit  of  a  species  of  pepper,  probably  the  Piper  angustifolium.  It  has 
a  pleasant  aromatic  odor,  and  a  slight  taste.  It  is  very  strongly  recom- 
mended as  an  astringent  to  check  haemorrhages  from  leech  bites,  etc., 
where  it  can  be  directly  applied.  It  is  also  used  internally  in  epistaxis, 
haemorrhage  from  the  bowels,  uterus,  etc.,  and  cases  have  multiplied  in 
which  most  wonderful  effects  are  said  to  have  been  realized  from  it. 
Whether  subsequent  experience  will  confirm  the  hopes  excited  by  these 
reports,  is  of  course  uncertain. 

Mode  of  Administration. — Inftisio7i.-*-(  3  i  to  Oj  water.)     Dose  3  j. 


REVULSIVES. 


Bv  Revulsives  are  meant  those  agents  which  excite  an  action  in  one 
part  of  the  system,  and  in  consequence  overcome  a  morbid  action  exist- 
ing in  some  other  part  They  are  also  called  Derivatives  and  Counter- 
irritants.  Usually  these  terms  are  limited  to  those  agents  which  are 
applied  to  the  external  surface  of  the  body.  They  might,  however,  be 
applied  with  equal  propriety  to  agents  taken  internally.  It  is  only  with 
those  acting  on  the  surface  that  we  have  now  to  do. 

Before  giving  an  account  of  individual  revulsives,  I  will  make  a 
remark  or  two  upon  the  principle  upon  which  they  are  supposed  to  act. 
In  observing  the  operations  of  the  animal  economy,  in  various  states  of 
derangement  from  perfect  health,  it  is  remarked  that  morbid  actions  or 
irritations  are  frequently  transferred  from  one  part  to  another,  and  that 
in  this  case  the  primary  one  not  uncommonly  yields  altogether  to  the 
secondary.  This  has  been  observed  so  repeatedly  as  to  justify  us  in 
considering  it  as  a  kind  of  general  law.  It  was  in  accordance  with  this 
that  John  Hunter  laid  down  the  too  sweeping  generalization  that  two 
diseases  could  not  exist  at  the  same  time.  Why  it  is,  or  how  it  is,  that 
one  irritation  thus  yields  to  another,  it  is  impossible  to  say,  and  I  shall 
therefore  not  spend  any  time  in  useless  speculation  in  relation  to  it. 

Now  it  is  upon  this  simple  law  or  fact  that  the  use  of  all  external 
revulsive  agents  is  founded,  experience  having  shown  that  actions  or 
irritations  excited  by  artificial  means  are  capable  of  producing  effects 
precisely  analogous  to  the  spontaneous  irritations  set  up  by  nature.  Re- 
vulsive medication,  then,  is  nothing  more  than  an  imitation  of  the 
method  of  cure  frequently  instituted  by  nature  herself.  This  is  the 
principle  upon  which  the  use  of  revulsive  agents  is  founded.  They  may 
be  divided  into  several  classes  according  to  the  degree  of  effect  which 
they  produce. 

1.  Those  which  simply  promote  the  flow  of  blood  to  the  part. 

2.  Those  which  produce  moderate  irritation. 

3.  Those  which  blister. 

4.  Those  which  produce  eruptions  of  various  kinds. 

5.  Those  which  destroy  the  texture  of  the  part — caustics,  issues. 


REVULSIVES.  505 

1.  Those  which  Promote  the  Flow  ov  Blood  to  the  Part. — To 

this  class  belong  friction,  warmth  applied  in  various  ways,  such  as  bottles 
of  hot  water,  bags  of  hot  salt,  etc.,  warm  bathing,  local  and  g<  neral. 
These,  though  simply  are  important  and  valuable  revulsive  agents. 
Under  continued  friction  the  sensibility7  and  beat  of  the  part  are  aug- 
mented, while  at  the  same  time  an  increased  flow  of  blood  takes  place* 
The  warm  bath  is  still  more  effective,  especially  if  impregnated  with  .-alt. 
By  these  agents  the  most  striking  and  beneficial  results  are  frequently 
produced  in  the  way  of  revulsion. 

2.  Those  which  produce  Moderate  Local  Irritation. — They  are 
commonly  called  rubefacients.  By  this  is  meant  those  substances  that 
simply  produce  redness,  and  a  certain  degree  of  irritation  of  the  pari  to 
which  they  are  applied,  without  causing  any  discharge.  They  arc  used 
with  great  advantage  in  many  cases  where  the  operation  of  blisters  would 
be  unnecessarily  severe.     Among  the  best  of  this  class  are  the  following  : 

Aqila  Ammonia. — This  may  be  used  either  pure  or  in  combination 
with  sweet  oil,  and  in  either  way  makes  an  excellent  rubefacient  applica- 
ton.  A  piece  of  flannel  soaked  in  aqua  ammonias  and  laid  on  the  skin 
will,  in  a  very  short  time,  excite  considerable  pain,  redness,  and  inflam- 
mation. If  the  strong  aqua  ammonias  is  used,  it  will  blister  very  speed- 
ily. The  more  common  form  of  using  it  is  in  combination  with  sweet 
oil,  and  then  it  forms  what  is  known  as  the  volatile  liniment.  In  this 
preparation  a  chemical  union  takes  place  between  the  oil  and  the 
ammonia,  and  a  white  soap  is  formed,  which  is  kept  fluid  by  the  water 
of  the  ammonia.  The  proportion  of  oil  and  ammonia  must  vary  with 
the  strength  required.  In  some  cases  equal  parts  are  necessary,  while 
iD  others  a  third  or  a  fourth  of  ammonia  will  answer.  For  children  the 
proportion  of  ammonia,  of  course,  must  be  less  than  for  adults. 

Sinapis. — This  is  perhaps  the  best  of  all  the  rubefacient  articles 
and  from  it  is  derived  the  term  sinapism.  If  it  be  desired  to  have  its 
full  strength,  it  is  prepared  by  mixing  the  pounded  mustard  with  water 
into  a  thick  paste  or  poultice.  The  common  practice  is  to  mix  it  with 
vinegar;  this,  however,  rather  impairs  the  strength  of  the  mustard. 
Applied  to  the  skin  in  this  state  in  a  very  few  minutes  it  causes  a  sense 
of  warmth  in  the  part,  and  in  the  course  of  half  an  hour  severe  pain. 
When  taken  off  the  skin  is  red  and  burning.  If  it  be  left  on  too  Jong, 
actual  vesication  takes  place,  and  in  some  cases  troublesome  ulceration 
follows.  This,  therefore,  should  be  avoided.  The  best  plan  is  to  remove 
it  as  soon  as  severe  pain  is  felt,  and  be  careful  in  leaving  it  too  long  on 
parts  possessed  of  little  vitality.  By  adding  flour,  its  strength  may  be 
regulated.  In  applying  it  to  children,  this  should  be  specially  attended 
to.  Although  an  exceedingly  efficient  and  useful  rubefacient,  this  article, 
therefore,  requires  to  be  managed  with  caution. 


506  MATERIA   MEDICA   AST)   THERAPEUTICS. 

Capsicum. — This  is  an  excellent  rubefacient,  and  used  in  various  forms. 
It  may  be  made  into  cataplasm,  or  the  saturated  tincture  may  be  rnb- 
bed  on  the  surface.  As  a  liniment  it  may  be  prepared  by  mixing  it 
with  hog's  lard.  Another  simple  and  good  form  of  using  it,  where 
counter-irritation  is  to  be  made  to  the  feet,  is  to  dust  the  insides  of  the 
stockings  with  the  dry  powder.  This  keeps  up  a  moderate  degree  of 
heat  and  irritation  in  the  feet,  and  is  exceedingly  useful  where  there  is 
a  tendency  to  coldness  of  the  extremities,  accompanied  with  head-ache. 

Oil  of  Turpentine. — This  is  also  a  good  rubefacient.  If  applied 
undiluted  it  causes  considerable  smarting  and  irritation,  and  is  sometimes 
followed  by  a  vesicular  eruption.  In  this  state  it  may  be  used  in  the 
way  of  friction,  by  means  of  a  piece  of  flannel  soaked  in  the  turpentine. 
The  more  common  way  in  which  it  is  used  is  that  of  a  liniment,  in 
combination  with  other  rubefacient  articles. 

Tincture  of  Cantharides. — This  is  sometimes  used  as  a  rubefacient ; 
and  the  experiments  of  Dr.  Alexander  prove,  that  when  made  by  putting 
3  i  of  cantharides  into  3  iv.  alcohol,  it  is  just  strong  enough  to  cause  irri- 
tation of  the  skin,  and  not  vesicate.  This  is  exactly  the  strength  ordered 
in  the  U.  S.  Pharmacopoeia.  An  ordinary  blister,  if  taken  off  early 
enouo-h,  may  be  made  to  produce  a  rubefacient  effect  only. 

Camphor  dissolved  in  alcohol  is  a  common  and  useful  rubefacient. 
It  is  one  of  the  ingredients  in  the  common  opodeldoc,  which  consists 
of  soap  §  iii,  alcohol  Oj,  camphor,  oil  of  rosemary,  oil  of  origanum, 
each  3  ss. 

Pix  Burgundica. — This  is  the  resin  obtained  from  the  Pinus  abias,  or 
fir  tree.  The  ordinary  inode  of  using  it  is  in  the  form  of  plaster. 
Applied  in  this  way  it  excites  in  the  course  of  a  day  or  two  consider- 
able irritation  of  the  part,  which  is  followed  by  a  slight  effusion  of 
serous  fluid.  From  the  mildness  and  slowness  of  its  action,  it  is  not 
adapted  to  cases  where  a  prompt  revulsion  is  called  for.  For  the  pur- 
pose of  rendering  it  more  active  and  irritating,  a  small  portion  of  blis- 
tering ointment  may  be  added  to  the  pitch,  while  cooling,  just  before 
the  plaster  is  spread. 

Allium  sativum. — Garlic  has  long  been  known  and  used  as  a  local 
irritant.  It  sometimes,  though  not  often,  causes  vesication.  It  is  used 
very  much  in  the  same  way  and  in  the  same  cases  as  mustard.  As  an 
application  to  the  feet  of  children  after  soaking  them  it  is  excellent. 

Oleum  Monardaz  Punctata. — The  Monarda  punctata,  or  horse  mint, 
is  a  native  plant  of  this  country,  and  yields  an  oil  which  possesses  admir- 
able rubefacient  properties.  If  rubbed  on  the  skin- it  speedily  causes 
redness  and  irritation,  and  sometimes  vesication  if  its  application  be  too 
long  continued.  It  was  first  noticed  by  Dr.  Atlee,  of  Philadelphia,  who 
recommends  it  in  the  form  of  a  liniment  with  camphor  and  opium. 
Properly  diluted  it  may  be  used  in  all  cases  where  an  ordinary  rubefa- 
cient is  required. 


REVULSIVES.  507 

3.  Those  which  blister. — These  are  called  epispastics  or  vi  icants. 
The  term  is  applied  to  those  agents  which  possess  the  power  of  irritat- 
ing and  inflaming  the  skin  in  such  a  way  as  to  he  followed  by  the  for- 
mation of  vesicles. 

The  effects  of  these  agents  are  obvious.  The  part  to  which  they  are 
applied  undergoes  all  the  changes  of  ordinary  inflammation,  [ncreased 
sensation  is  first  experienced,  then  comes  on  heat,  redness,  swelling,  and 
pain.  To  these  succeeds  an  effusion  of  serous  fluid  from  the  excited  ex- 
halants,  and  a  consequent  separation  of  the  cuticle,  forming  a  vesicle  or 
blister.  On  removing  the  epispastic  and  discharging  the  serum,  the 
part,  unless  again  irritated,  gradually  heals,  new  cuticle  forms,  and  in  a 
few  days  the  whole  is  restored  to  its  natural  state. 

With  these  local  effects  the  constitution  is  more  or  less  sympatheti- 
cally affected.  Like  all  local  inflammations,  the  effect  of  blisters  is  to 
increase  the  action  of  the  heart  and  arteries.  The  vascular  excitement 
thus  produced,  however,  is  rarely  excessive,  and  speedily  subsides  with 
the  removal  of  the  cause  producing  it.  The  nervous  system,  too,  is  ex- 
cited by  the  action  of  blisters.  In  certain  conditions  of  that  system,  the 
stimulus  of  these  agents  increases  the  tone  and  energy  of  the  brain. 
This  is  so  marked  that  some  persons  have  resorted  to  the  application  of 
them  previously  to  great  mental  efforts.  The  celebrated  English  barris- 
ter, Dunning,  is  reported  to  have  been  in  this  habit.  Dr.  Thompson 
states,  that  the  late  Sir  James  Mackintosh  tried  the  effect  of  it  in  one 
of  his  efforts  before  the  House  of  Commons,  and  with  great  success. — 
Vol.  ii.  p.  535. 

Blisters,  then,  act  both  as  local  and  general  stimulants.  This  double 
operation  it  is  important  to  bear  in  mind  in  the  application  of  these 
agents  in  different  stages  of  disease.  The  effects  of  blisters  are  modi- 
fied by — 

(a.)  Age. — From  the  peculiar  delicacy  of  the  skin  in  young  subjects 
blisters  produce  their  effects  much  more  speedily  than  in  adults,  at  the 
same  time  that  the  constitutional  irritation  which  they  occasion  is  much 
greater.  In  some  cases,  especially  if  left  ou  too  long,  the  inflammation 
runs  rapidly  into  gangrene,  and  proves  fatal.  In  young  subjects,  there- 
fore, the  greatest  caution  should  be  exercised  in  watching  the  effects  of 
blisters.  [I  think  that  blisters  should  be  banished  from  the  therapeutics 
of  children.]  In  old  persons,  too,  from  the  torpid  condition  of  the  capil- 
laries, the  inflammation  of  a  blister  may  readily  assume  an  unhealthy 
character. 

(b)  Sex. — From  the  greater  delicacy  of  the  female  system,  blisters  as 
a  general  rule  are  apt  to  produce  more  irritation  thau  in  males.  In  the 
use  of  them  this  fact  ought  always  to  be  borne  in  mind.  During  the 
state  of  pregnancy  their  effect  is  modified.  The  system  then  is  in  a 
state  of    increased  excitability,  and    in  consequence  of  this    the  local 

33 


508  MATERIA    MEDICA   AND    THERAPEUTICS. 

as  well  as  general  irritation  which  they  produce  is  apt  to  be  much 
greater.  According  to  Dr.  Dewees  they  are  more  apt  during  pregnancy 
to  produce  strangury.  In  some  cases,  too,  premature  labor  has  been 
produced  by  them.     Dewees  records  two  instances  of  this  sort.* 

The  peculiar  Character  of  the  Skin. — It  is  well  known  that  in  this 
respect  there  is  every  variety.  In  some  persons  the  skin  is  naturally 
thin,  delicate,  and  irritable.  In  these  the  slightest  causes  frequently  ex- 
cite an  unnatural  degree  of  inflammation,,  followed  by  proportional  con- 
stitutional disturbance.  In  others,  again,  the  skin  is  thick,  tough, 
and  torpid ;  in  these,  of  course,  local  irritations  are  more  tardily  pro- 
duced, and  affect  the  system  less.  Now,  in  these  different  states  of  the 
skin  it  is  evident  that  the  effects  of  blisters  must  differ  considerably. 

(d.)  Temperament  or  general  habit  of  Body. — This  also  greatly  mo- 
difies the  effects  of  blisters.  In  irritable  habits  they  frequently  cause  a 
great  degree  of  nervous  and  vascular  excitement.  I  have  met  with  cases 
of  this  kind  in  which  a  state  little  short  of  phrensy  has  been  induced. 
In  habits  of  an  opposite  character  they  produce  little  or  no  constitu- 
tional irritation.  In  persons  much  reduced  and  broken  down  by  debili- 
tating causes,  troublesome  ulceration  and  gangrene  not  unfrequently 
follow  their  application. 

(e.)  The  part  to  which  the  Blister  is  applied  modifies  its  effect.  A  blis- 
ter applied  to  the  scalp  takes  twice  the  time  to  produce  its  effect  that 
t  does  on  other  parts.  If  a  blister  be  applied  to  the  scalp  immediately 
after  the  hair  is  shaved  off,  strangury  is  almost  always  produced,  an 
effect  which  does  not  follow  if  the  application  be  delayed  for  twenty- 
four  hours.f 

(/.)  The  length  of  time  the  Blister  is  kept  applied  modifies  greatly  its 
effects.  In  the  case  of  the  ordinary  blister,  if  the  application  ,be  conti- 
nued beyond  a  certain  time,  strangury  is  apt  to  be  induced. 

(g.)  The  actual  condition  of  the  patient  as  to  disease. — No  circum- 
stance modifies  in  so  important  a  manner  the  effects  of  blisters  as  this. 
If  applied  in  the  early  stages  of  high  inflammatory  or  febrile  excitement, 
they  act  as  general  irritants,  increasing  heat  and  quickening  the  pulse  ; 
while  in  the  more  advanced  periods  they  produce  a  salutary  revulsion 
without  any  of  these  effects.  In  certain  conditions  of  the  brain  and 
nervous  system,  the  skin  loses  its  sensibility,  and  blisters  do  not  produce 
any  effect. 

From  what  has  already  been  advanced,  it  must  be  evident  that  there 
are  certain  conditions  of  the  system  in  which  blisters  are  contra-indi- 
cated. As  a  general  rule  they  ought  never  to  be  used  where  there  is 
present  a  high  degree  of  general  febrile  or  inflammatory  excitement. 
The  reason  of  this  must  be  obvious,  if  we  reflect  for  a  moment  upon  the 

*  Treatise  on  Females,  p.  128-9.  f  Percival's  works,  v.  i.  p.  129. 


REVULSIVES.  509 

effects  of  a  blister.  These  are  local  irritation  and  general  excitement. 
Now  in  all  cases  where  ;i  local  inflammation  exists,  the  difficulty  of 
resolving  it  by  any  means  will  always  In;  pro| .<>rt i< .ii<;f!  to  the  degree  of 
general  excitement  accompanying  it.  If  a  blister  be  applied  when  the 
general  excitement  is  already  very  great,  one  of  tin:  effects  will  Ik:  to 
aggravate  this,  and  thus  to  counteract  tlic  beneficial  agency  of  the  blister 
as  a  revulsive.  Under  these  circumstances  tin:  primary  inflammation, 
instead  of  being  relieved,  must  !»■  aggravated  by  the  increase  of  the 
general  excitement.  Hence  it  lias  been  generally  observed  thai  if  blis- 
ters bo  applied  in  cases  where  great  general  excitement  is  present,  ante- 
cedently to  suitable  evacuations,  they  do  more  harm  than  good.  They 
merely  add  fuel  to  the  fire. 

Another  condition  of  the  system  in  which  they  are  contra-indicated 
is  thai  in  which  great  constitutional  exhaustion  is  present.  From  the 
impaired  state  of  the  vital  powers,  gangrene  and  death  may  ensw<-. 

The  condition  of  the  system  most  favorable  to  their  use  is  that  in 
which  the  general  excitement  is  rather  below  than  above  the  natural 
standard.  In  this  state  of  things  irritations  are  most  readily  transferred 
from  one  part  to  another. 

Modus  in  which  Blisters  prove  Curative. — There  are  three  : 

1.  .By  exciting  a  new  action  in  the  part  to  which  they  are  directly 
applied.     In  this  way  they  sometimes  arrest  the  progress  of  erysipelas. 

2.  By  their  stimulating  effect  on  the  general  system.  In  this  way 
they  sometimes  prove  beneficial  in  low  fevers,  in  paralysis,  &c. 

3.  As  derivatives  they  relieve  inflamed  and  congested  parts  by  direct- 
ing the  flux  of  blood  to  the  surface  and  from  the  diseased  part  or  organ.. 


INDIVIDUAL    EPISPASTICS. 

CANTHARIDES. 

The  iusect  used  for  ordinary  blistering  is  the  Meloe  vesicatorius,  or 
more  properly  the  Cantharis  vesicatoria.  It  is  found  adhering  to  the 
leaves  of  a  number  of  plants,  such  as  the  ash,  elder,  lilac,  white  poplar, 
&c,  in  Spain,  France,  and  Italy.  From  its  having  been  made  an  article 
of  commerce  more  particularly  in  Spain,  it  has  received  the  name  of  the 
Spanish  fly.  The  mode  of  collecting  them  is  by  simply  shaking  them 
from  the  branches  of  the  trees  early  in  the  morning,  while  they  are  yet 
in  a  torpid  state  from  the  cold  of  the  previous  night.  This  is  done  by 
persons  covered  with  masks  and  gloves,  who  receive  them  on  cloths 
spread  under  the  tree.     After  this  they  are  instantly  put  into  a  sieve 


510  MATERIA   MEDICA   AND   THERAPEUTICS. 

and  exposed  to  the  fumes  of  boiling  vinegar.     This  kills  them,  and  after 
this  they  are  dried  either  by  the  sun  or  in  a  stove. 

The  cantharides  belong  to  the  beetle  tribe  of  insects.  They  are 
from  six  to  ten  lines  in  length,  and  two  or  three  in  breadth,  of  a  golden 
greenish  color,  and  when  alive  have  a  foetid,  penetrating  odor,  by  which 
swarms  of  them  may  be  detected  at  a  distance.  At  Dijon,  in  France, 
it  is  stated  that  the  public  walks  were  at  one  time  deserted  in  con- 
sequence of  the  disagreeable  odor  occasioned  by  these  animals. — Diet. 
Mat.  Med.,  vol.  iv.  p.  300. 

When  dried  they  retain  a  good  deal  of  this  offensive  odor;  their  taste 
is  acrid.  The  powder  which  they  yield  is  of  a  greyish  brown,  mixed 
with  shining  particles. 

To  have  them  good  they  should  be  kept  perfectly  dry;  when  suf- 
fered to  become  moist  they  lose  their  vesicating  property.  They  should, 
therefore,  be  occasionally  spread  out  and  exposed  to  the  air.  If  kept 
in  bottles  tightly  closed,  they  retain  their  virtues  for  a  great  length  of 
time. 

Adulterations. — In  the  state  of  powder  cantharides  may  very  easily 
be  adulterated  by  the  admixture  of  various  articles.  The  only  way  to 
obviate  this  is  to  buy  in  the  insect  state. 

In  this  state,  however,  they  are  frequently  mixed  with  another  insect, 
the  Jfelolontka  vitis.  This  is  distinguished  by  its  square  form  and  black 
feet ;  as  this  insect  does  not  possess  any  vesicating  power,  it  should  be 
carefully  separated. 

Chemical  '■Composition,  &c. — By  the  researches  of  modern  chemistry 
the  vesicating  property  of  the  cantharides  has  been  found  to  reside  in  a 
peculiar  principle  which  is  called  Cantharidin.  This  was  discovered  by 
Robiquet  in  1810.  It  is  obtained  in  small  crystalline  micaceous  plates, 
insoluble  in  water  and  cold  alcohol,  but  soluble  in  boiling  alcohol,  ether, 
and  oil. 

Effects. — The  effects  of  cantharides  applied  as  a  blister  are  those 
already  described  under  the  head  of  epispastics  generally.  In  addition 
to  these,  however,  they  produce  under  certain  circumstances  strangury, 
a  peculiar  irritation  of  the  urinary  organs,  accompanied  by  a  spasmodic 
constriction  of  the  sphincter  of  the  bladder.  There  are  great  pain  and 
difficulty  in  voiding  urine,  and  the  quantity  which  is  discharged  is 
exceedingly  small.  The  circumstances  under  which  this  effect  is  most 
likely  to  occur,  are  those  in  which  the  protecting  power  of  the  cuticle 
is  either  impaired  or  entirely  destroyed.     Thus  : 

.1.  When  the  blister  is  kept  on  so  long  that  the  cuticle  is  entirely 
.removed,  and  the  blister  then  comes  in  actual  contact  with  the  sub- 
jacent parts. 

2.  When  the  blister  is  applied  to  a  part  recently  shaved,  as  a  scalp. 

3.  When  the  blister  is  applied  to  parts  where  the  cuticle  is  already 


REVULRIVKS.  .r,  1  ) 

destroyed,  either  by  previous  blistering,  wounds,  ulcerated  surface,  or 
the  like.     Under  ;il!  these  circumstances  may  this  effeel  be  produced. 

Modes  of  Application . — The  Ointment. — This  is  the  ordinary  and 
best  mode  of  applying  cantharides  for  the  purpose  of  vesication.  This 
ointment  is  made  of  resin,  wax,  and  oil,  or  lard.  In  preparing  it,  great 
care  should  be  taken  not  to  add  the  flies  to  the  other  ingredients  while 
they  are  hot,  as  heat  impairs  the  vesicating  power.  This  is  the  reason 
why  in  the  pharmacopoeia  it  is  directed  that  the  flies  are  to  be  added 
just  as  the  other  ingredients  are  cooling  and  becoming  solid,  for  the 
same  reason,  in  spreading  a  blister,  care  should  be  taken  not  to  soften 
the  ointment  by  means  of  heat. 

In  preparing  and  applying  a  blistering  plaster,  there  are  several  things 
important  to  be  observed : 

1.  The  plaster  should  be  spread  thick.  If  this  is  properly  done,  the 
vesication  is  not  only  more  certain,  but  is  produced  in  a  shorter  time. 
On  the  other  hand,  if  the  plaster  be  spread  thin,  the  vesication  is  apt  to 
be  imperfect  and  in  patches,  and  requires  a  longer  time.  Linen  is  better 
than  leather. 

2.  The  practice  so  very  common  of  sprinkling  the  plaster  over  with 
dry  fly  powder  cannot  be  too  severely  reprobated.  Although  intended 
to  make  the  blister  more  potent,  it  always  has  a  contrary  effect.  The 
blister  never  draws  so  well,  probably  in  consequence  of  its  not  adhering 
so  closely  to  the  skin.  Besides  strangury  is  much  more  apt  to  follow 
from  the  particles  of  the  powder  adhering  after  the  blister  has  been 
removed. 

3.  Let  the  surface  to  which  the  blister  is  applied  be  properly  cleansed, 
and  if  it  be  cold  and  torpid,  or  if  you  wish  the  blister  to  act  very 
promptly,  stimulate  the  skin  by  some  rubefacient,  as  turpentine,  mus- 
tard, or  the  like. 

4.  It  is  important  that  every  portion  of  the*  blister  plaster  should  be 
kept  in  actual  contact  with  the  skin,  otherwise  the  vesication  will  be  in 
patches.  To  prevent  this,  put  a  bandage  over  the  blister,  or  fasten  its 
edges  down  with  adhesive  straps. 

5.  The  usual  period  for  leaving  on  a  blister  in  an  adult  is  twelve 
hours,  but  there  is  every  variety,  as  before  noted,  in  the  sensibility  of 
the  skin ;  the  best  plan  is  to  raise  a  corner  of  the  plaster  after  eight 
hours,  and  if  small  vesicles  are  formed,  the  work  is  done,  the  plaster 
may  be  removed,  and  simple  cerate  substituted. 

6.  Where  blisters  are  used  to  subdue  internal  inflammation,  they 
should  be  large ;  the  same  amount  of  irritation  follows  a  small  as  a  large 
blister,  and  the  amount  of  proper  and  useful  counter-irritation  is  null. 

7.  Remember  that  in  internal  inflammations,  the  great  principle  on 
which  blisters  prove  curative  is  that  they  excite  an  irritation  more 
powerful  than  the  inflammations.     Of  course,  when  the  inflammation 


512  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

runs  high,  this  is  impossible ;  always  under  such  circumstances  reduce 
the  inflammation  to  the  blistering  point  by  venesection,  evacuants,  &c. 

4.  Agents  which  produce  Eruptions  and  Pustules. — These  differ 
very  materially  in  their  effects  from  blisters.  They  are  more  permanent 
in  their  operation.  The  inflammation  which  they  produce  is  of  the 
phleo-monous  character,  while  that  excited  by  blisters  is  erythematic. 

(a.)  Tartar  Emetic. — Although  the  peculiar  effects  of  this  substance 
on  the  skin  had  been  previously  noticed,  and  some  practical  applica- 
tions had  been  made  of  it,  yet  it  was  not  until  the  year  1821  that  it 
was  fully  brought  before  the  public  as  a  revulsive  agent.  In  an  essay 
written  expressly  on  this  subject,  Dr.  Jenner  gave,  at  that  time,  a  full 
account  of  its  successful  application,  and  since  then  it  has  been  in  exten- 
sive use.  There  are  two  modes  in  which  it  may  be  applied — in  the 
form  of  strong  solution  or  of  an  ointment.  Rubbed  on  the  skin  in 
either  way,  local  irritation  is  first  produced,  which  is  succeeded  by  a 
crop  of  pustules,  resembling  in  their  appearance  and  progress  those  of 
small-pox.  The  first  of  these  modes  was  originally  suggested,  in  1773, 
by  Dr.  Bradley,  of  London.  The  second  is  that  recommended  by  Dr. 
Jenner,  and  is  the  one  commonly  used  at  present.  The  formula  for  the 
ointment,  as  proposed  by  Dr.  Jenner,  is  the  following : 

JJ     Antimon.  Tart,  (subtil,  pulv.)  3  ij. 
Ung.  Cetacei         .         .  3  ix. 

Sacch.  alb.    .         .         .  3  i. 

Hyd.  sulph.  rub.   .         .         gr.  v.         Mi 

The  sugar  is  added  merely  to  prevent  the  ointment  from  becoming 
rancid.  Every  purpose,  however,  may  be  answered  by  simply  rubbing 
up  a  suitable  proportion  of  tartar  emetic  with  lard.  The  length  of  time 
which  it  takes  to  produce  its  effects,  varies  with  the  strength  of  the 
application  and  the  susceptibility  of  the  skin.  When_it  is  desirable  to 
brino-  out  the  pustules  as  speedily  as  possible,  the  skin  should  be  previ- 
ously prepared  by  friction,  either  dry  or  with  strong  vinegar.  The  oint- 
ment should  then  be  rubbed  on  the  part  briskly  for  ten  or  fifteen 
minutes.  In  this  way  a  crop  of  pustules  will  be  brought  out  in  a  few 
hours.  Where  it  is  not  required  to  produce  the  effect  so  rapidly,  a 
portion  of  the  ointment  may  be  rubbed  on  the  part  for  a  few  minutes 
twice  a  day  ;  and,  generally,  in  the  course  of  one,  two,  or  three  days,  the 
effect  will  begin  to  show  itself. 

"When  the  solution  is  used,  after  preparing  the  skin  by  friction,  it 
should  be  applied  as  hot  as  it  can  be  borne.  Pustules  are  thus  rapidly 
produced.     "  They  are  small  and  numerous,  and  speedily  heal,  leaving 


REVULSIVES.  518 

no  traces  behind  them." — Thompson,  vol.  ii.  \>.  r,r>r,.    This  is  a  mode 
well  suited  to  females. 

When  the  eruptions  come  out  large  and  full,  they  are  sometirm 
ceedingly  painful,  and  cause  a  good  deal  of  irritation.    The  best  dn    - 
ing  in  this  case  is  a  bread  and  milk  poultice  or  simple  cerate. 

If  it  be  desirable  to  keep  out  the  eruption  for  some  time,  fresh  appli- 
cations of  the  ointment  may  be  made. 

From  the  effects  of  tartar  emetic  thus  applied,  it  is  evident  that  its 
action  is  entirely  different  from  that  of  an  ordinary  blister.     It  not  m< 
irritates  the  skin,  but  produces  actual  disease  of  that  structure,  and  to 
this  circumstance,  no  doubt,  may  its  efficacy  in   many  eases,  as  a  revul- 
sive, be  attributed. 

(l>.)  CiiOTON  Oil. — Rubbed  on  the  skin,  croton  oil  produces,  after  two 
or  three  days,  a  fine  pustular  eruption.  It  is  usually  combined  with  two 
or  three  parts  of  olive  oil.  As  a  revulsive  it  is  less  severe  than  tartar 
emetic,  and  more  permanent  in  its  operation  than  a  blister.  It  some- 
times, but  rarely,  purges,  which  is  an  objection  to  its  use. 

(c.)  Nitro-Muriatic  Liniment. — A  liniment  composed  of  nitro-muri- 
atic  acid  and  spirits  of  turpentine,  produces  effects  somewhat  similar  to 
those  of  croton  oil.  It  is  made  by  mixing  two  parts  of  acid  with  one 
of  turpentine,  and  five  of  camphorated  oil  or  simple  lard.  Rubbed  with 
a  sponge  on  the  skin  it  will  cause  redness  and  heat  in  four  or  five  min- 
utes. If  continued,  small  vesicles  make  their  appearance,  and  a  further 
rubbing  causes  excoriation  and  a  free  exudation  of  serum.  As  a  local 
irritant  this  has  the  advantage  of  producing  immediate  effect.  The  pain 
is  said  not  to  be  very  severe. 

This  is  said  to  be  the  liniment  of  the  notorious  London  Quack,  St. 
John  Long. 

There  remain  only  to  be  considered  those  revulsives  which  destroy  the 
texture  of  the  parts  to  which  they  are  applied,  or  so  affect  it  as  to  cause 
a  permanent  suppuration,  or  as  the  phrase  goes,  keep  up  a  discharge 
from  the  part.     These  are  issues,  setons,  and  moxas. 

Issues. — These  are  artificial  ulcers  created  in  different  parts,  to  pro- 
duce local  irritation  and  a  purulent  discharge. 

They  are  made  in  different  ways : 

1.  By  making  permanent  blisters.  This  is  done  by  dressing  the 
blistered  surface  with  some  irritating  salve,  as  savin  or  the  like,  so  as  to 
keep  it  open  and  promote  suppuration. 

The  best  salve  for  this  purpose  is  Ung.  cantharidis  one  part,  Ung. 
Sabinse  seven  parts. 

2.  By  making  an  incision  of  suitable  size,  and  putting  one  or  more 
peas  in  it,  securing  them  by  a  bandage  or  an  adhesive  strap. 


514  MATERIA   MEDICA    AND   THERAPEUTICS. 

3.  By  applying  pure  nitric  acid  or  caustic  potassa  to  the  part,  and  thus 
destroying  the  vitality  of  the  skin.  When  this  sloughs  out,  the  sore 
may  be  kept  open  either  by  peas  or  by  the  occasional  use  of  an  irritating 
salve. 

4.  Issues  may  be  made  by  the  actual  cautery.  In  using  this,  great 
care  is  required  to  have  the  iron  at  a  white  heat,  and  to  apply  it  rapidly. 
This  is  much  used  in  France,  especially  to  the  os  uteri. 

Seton. — This  is  a  cord  of  silk  or  thread  inserted  by  means  of  a  flat 
seton  needle  under  a  small  portion  of  the  skin  and  cellular  tissue ;  it 
soon  excites  a  suppuration,  which  may  be  increased  by  drawing  the 
thread  backwards  and  forwards,  and  also  by  putting  an  irritating  oint- 
ment on  the  thread  and  drawing  it  into  the  wound.  Of  these  modes  of 
getting  a  discharge  from  the  skin  the  blister  issue  is  the  least  severe,  the 
seton  the  most  so,  and  probably  the  most  effectual.  The  nitric  acid 
issue  is  preferred  by  most  surgeons,  I  believe. 

Situations  in  which  Issues  or  Setons  may  be  made. — They  should  not 
be  put  over  a  bone  or  tendon  when  covered  only  by  skin,  nor  in  imme- 
diate proximity  to  a  large  nerve  or  blood-vessel,  nor  on  the  belly  of  a 
muscle.  The  best  situations  are: — -1st.  The  back  of  the  neck.  2d. 
The  middle  of  the  humerus,  near  the  insertion  of  the  deltoid.  3d.  In 
the  hollow  on  the  inside  of  each  knee,  above  the  flexor  tendons.  4th, 
On  each  side  of  the  spinous  processes  of  the  vertebrae.  These  are  the 
best  places,  but  issues  may  be  put  where  there  is  beneath  the  skin 
enough  cellular  substance  to  protect  the  parts  below. 

Effects  as  compared  with  Blisters. — Issues  produce  less  local  irritation 
and  more  discharge,  and  their  operation  is  much  slower. 

Moxa. — This  remedy  was  introduced  by  Baron  Larrey,  who  became 
acquainted  with  it  during  Napoleon's  campaigns  in  Egypt.  It  is  made 
by  rolling  carded  cotton  or  some  similar  combustible  into  a  cylinder 
about  an  inch  long  and  half  as  thick.  This  is  applied  to  the  skin  and  kept 
in  contact  with  it  by  means  of  a  metallic  ring  and  handle.  The  moxa 
is  then  set  on  fire,  and  the  combustion  hastened,  if  necessary,  by  a  blow- 
pipe. The  influence  of  the  fire  should  be  limited  by  covering  the  part 
with  a  bit  of  wet  cloth,  having  a  hole  in  its  centre  the  size  of  the  moxa ; 
when  the  combustion  is  completed  the  parts  should  be  washed  with 
strong  aqua  ammonise,  which  greatly  relieves  the  pain.  An  eschar 
is  thus  formed,  and  when  the  slough  separates  it  may  be  dressed 
with  ointment,  stimulating  or  not,  as  it  is  desired  to  heal  or  keep  open 
the  sore.  The  effect  of  the  moxa  differs  from  the  actual  cautery  with 
the  iron,  in  that  the  heat  being  more  gradually  applied  penetrates 
deeper.  The  same  rules  and  restrictions  as  to  the  parts  on  which  they 
may  or  may  not  be  placed,  apply  to  moxas  as  to  issues.  Moxas  are 
made    of  cotton,  recommended    by  Larrey  •    this   may  be    previously 


REVULSIVES.  515 

soaked  in  a  solution  of  nitre  or  chlorate  of  potash  ;  or  of  a  coil  of  paper 
similarly  soaked  and  dried;  or  the  bulb  of  the  sunflower.  Their  effecte 
do  not  vary,  the  degree  of  inflammation  depending  on  the  closeness  with 
which  the  moxa  is  applied  to  the  skin,  its  size,  and  the  intensity  of  the 
combustion. 


PRACTICAL    APPLICATION    OF    REVULSIVES. 

1.  Of  those  which  simply  promote  the  flow  of  blood  to  the  surface. 
Wherever  internal  congestions  exist,  and  the  surface  is  consequently 
cold,  torpid,  and  comparatively  bloodless,  revulsives  of  the  first  class 
are  proper.  Hence  their  use  in  the  early  stages  of  fevers,  inflam- 
mations, and  congestive  diseases.  Their  range  is  from  the  slight  ch ill- 
ness produced  by  transient  exposure  to  cold,  and  cured  by  soaking  the 
feet  at  bed-time,  to  the  intense  congestion  of  typhus,  when  the  whole 
body  may  be  enveloped  in  hot  blankets,  or  the  hot  bath  used. 

2.  The  rubefacients  act  in  the  same  way,  and  are  appropriate  in  the 
same  wide  range  of  cases. 

3.  Of  Blisters. — These,  though  acting  on  the  same  principle,  are 
used  in  cases  where  the  difficulty  to  be  overcome  is  of  a  more  serious  and 
more  permanent  character.  As  blisters  are  extensively  used,  and  as 
their  use,  unlike  that  of  the  two  previous  classes,  is  pretty  sure  to  do 
harm  when  it  does  no  good,  let  us  refer  iu  detail  to  some  of  the  diseases 
in  which  they  are  used. 

1.  Fevers. — Here  everything  will  depend  on  the  stage  of  the  disease, 
and  the  state  of  the  system.  Blisters  should  never  be  used  till  the 
general  excitement  has  given  way  to  the  use  of  evacuants  ;  then  they  aid 
in  breaking  up  the  remains  of  the  disease,  and  preventing  or  removing 
local  determinations. 

2.  Inflammations. — The  use  of.  blisters  in  internal  inflammations  is 
very  common  and  very  beneficial.  The  same  rules  are  to  control  the 
time  of  their  application  as  have  been  so  often  repeated.  The  general 
excitement  must  be  in  some  degree  subdued,  the  vehemence  of  inflam- 
matory action  checked,  else  will  blisters  add  fuel  to  the  flame,  and 
increase  the  diseased  action  they  were  meant  to  control.  The  good 
they  can  do  is  limited  to  certain  stages  of  the  disease,  and  states  of  the 
system.    To  go  a  little  into  the  consideration  of  particular  inflammations : 

1.  Those  of  the  Thoracic  Cavities. — Here  blisters  show  their  best 
powers,  and  if  only  the  disease  has  been  checked  by  depletion,  or  if  its 
original  character  was  not  too  violent,  they  will  produce  great  and  good 
results. 

2.  In  Inflammations  of  the  Abdominal  Viscera. — Here,  too,  blisters 
will  sometimes  produce  the  best  curative  effects.     An  objection  to  their 


516  MATERIA   MEDICA    AND   THERAPEUTICS. 

use  is  that  they  deprive  us  of  the  use  of  pressure  as  a  test  of  the  pro- 
gress of  disease.  This  is  an  additional  reason  for  not  using  them  very 
early. 

3.  Inflammation  of  the  Brain. — Here,  too,  blisters  are,  by  universal 
consent,  remedies  of  great  value,  but  a  question  is  raised  as  to  where 
they  should  be  applied.  Some  shave  and  then  blister  the  scalp ;  others 
apply  the  blister  to  the  nape  of  the  neck,  or  even  to  more  distant  parts. 
I  believe  the  latter  is  the  true  practice  ;  from  the  peculiarities  in  the 
cerebral  circulation,  it  is,  I  think,  impossible,  or  nearly  so,  to  cause 
determination  to  the  scalp,  without  causing  a  like  determination  to  the 
brain  itself.  Hence  the  advantage  of  putting  the  blister  at  a  distance ; 
and  this  I  believe  common  experience  has  sanctioned.  The  best  places 
are  over  the  stomach,  on  the  back  of  the  neck,  along  the  spine,  and 
upon  the  extremities.  They  create  a  revulsion  from  the  brain,  take  off 
the  current  of  blood  from  the  organ,  and  often  produce  a  most  salutary 
influence  on  the  disease,  co-operating  markedly  with  other  remedies, 
as  purgatives,  &c,  &c. 

4.  Inflammation  of  the  Veins,  or  Absorbents  in  the  Extremities. — In 
these  inflammations  the  application  of  a  blister  along  the  whole  track  of 
the  vessel  will  often  produce  the  most  admirable  effects. 

5.  Inflammation  of  the  Joints. — Whether  the  disease  be  acute  or 
chronic,  advantage  can  be  derived  from  blisters.  They  are  best  used 
as  successive  blisters,  allowing  one  to  heal  before  the  other  is  applied. 
This  practice  we  owe,  I  believe,  to  Dr.  Physic  of  Philadelphia. 

USE    OF    ISSUES    AND    SETONS    IN    DISEASE. 

From  the  nature  and  mode  of  their  operation  it  is  obvious  that  these 
revulsives  act  very  little,  if  at  all,  as  counter-irritants,  and  mainly  as 
local  depletants  and  derivatives.  From  the  slowness  of  their  action, 
too,  they  are  unavailing  where  an  immediate  impression  is  required. 
All  these  facts  look  to  their  employment  in  chronic  cases,  and  in  such 
mainly  are  they  used.  When  the  habit  is  full,  this  fulness  may  en- 
danger particular  organs,  as  the  brain;  the  danger  can  often  be  warded 
off,  and  the  current  made  to  set  in  a  different  direction,  by  establishing 
an  issue.  Hence  their  use  to  prevent  apoplexy.  In  chronic  inflamma- 
tions they  are  used,  I  think,  less  than  formerly,  practitioners  preferring 
repeated  blisters  to  the  action  of  an  issue. 

Moxa. — Baron  Larrey  first  used  moxas  in  paralysis,  and  was  very 
successful ;  subsequently  he  and  others  have  used  them  in  various 
spasmodic  affections,  and  in  neuralgia,  chronic  affections  of  the  abdomi- 
nal viscera,  rachitis,  morbus  coxarius.  By  Wallace  it  was  used,  and 
highly  recommended,  in  a  very  wide  range  of  neuralgic,  paralytic,  and 
rheumatic  affections,  epilepsy,  and  other  spasmodic  diseases.  It  has 
rather  lost  than  gained  ground  during  the  last  ten  years. 


ALTERATIVES 


In  a  certain  sense  all  medicines  arc  alteratives,  inasmuch  as  they  pro 
duce  more  or  less  alteration  in  the  existing  state  of  the  system.  Com- 
mon usage  has,  however,  restricted  the  term  to  a  particular  class  of 
medicinal  agents.  In  this  restricted  application,  ft  is  used  to  designate 
those  remedies  which,  without  causing  any  very  marked  or  sensible 
evacuations,  act  upon  the  system  at  large  and  produce  a  gradual 
change  in  its  condition. 

Pliysiological  Effects. — If  given  in  a  suitable  way,  these  agents 
generally  prove  excitant  to  the  digestive  organs.  The  appetite  is 
increased,  perspiration  promoted,  the  quantity  of  urine  considerably 
augmented,  and  the  health  improved.  If  their  use  be  continued  beyond 
a  certain  period,  however,  other  effects  are  produced.  General  excite- 
ment comes  on,  and  the  specific  effects  of  the  individual  agents  are 
developed.  If  their  use  be  still  further  persisted  in,  they  prove 
poisonous. 

In  addition  to  these,  the  proper  alteratives,  there  are  certain  other 
agents  which  I  shall  consider  under  this  head,  distinguishing  them  as 
local  alteratives  (those  which  change  the  vital  action  of  the  particular 
part  to  which  they  are  applied)  and  chemical  alteratives,  or  those 
which  produce  their  curative  effects  by  a  chemical  change  in  the  various 
fluids  of  the  body.  Under  the  first  of  these  sub-classes,  I  shall  speak  of 
those  agents  more  commonly  called  caustics,  and  under  the  latter  of 
antacids  and  antilithics. 

Peculiarities  of  this  Class  of  Agents. — The  particulars  in  which 
alteratives  differ  from  other  classes  of  medicinal  agents  are  : — 

They  require  to  be  taken  in  minute  doses  and  repeated  at  stated 
intervals,  and  continued  for  a  certain  length  of  time.  Unless  this  is 
done,  the  effect  is  not  obtained. 

The  period  required  varies  according  to  circumstances;  but  the 
average  for  a  full  course,  perhaps,  may  be  put  at  from  two  to  four 
months. 

Mules  to  be  Observed  during  their  Use. — 1.  During  a  course  of  alter- 
ative treatment,  particular  attention  should   be   paid   to  the  patient's 


518  MATERIA.  MEDICA   AND   THERAPEUTICS. 

general  mode  of  living.  As  the  course  of  medication  through  which  he 
has  to  go  is  long  and  debilitating,  it  is  improper  to  reduce  his  general 
powers  by  a  too  abstemious  diet.  On  the  other  hand,  care  should  be 
taken  that  all  excitement  should  be  avoided.  The  best  general  rule  is 
to  let  him  live  according  to  his  usual  mode,  reducing  somewhat  the 
quantity,  of  animal  food  and  interdicting  altogether  the  use  of  stimulants, 
whether  in  the  shape  of  drinks  or  of  higb-seasoned  food. 

2.  The  clothing  of  the  patient  should  be  particularly  attended  to — as 
one  great  object  is  to  keep  up  an  equable  action  on  the  skin,  so  as  to 
secure  the  general  operation  of  the  remedies  upon  the  whole  system. 
Flannel  should  always  be  worn  next  the  skin  in  the  winter  and  spring, 
and  cotton  during  the  warm  weather  of  summer. 

3.  Frequent  recourse  should  be  had  during  a  course  of  alterative 
treatment,  to  the  use  of  the  tepid  bath  92°  to  94°.  This  co-operates 
very  powerfully  in  determining  to  the  surface,  equalizing  the  circulation, 
and  lessening  general  irritability. 

4.  The  digestive  organs  should  be  especially  attended  to.  In  propor- 
tion as  they  are  kept  in  due  order  will  the  specific  operation  of  the 
alterative  be  obtained. 

5.  Above  all  things,  in  an  alterative  course  (more  especially  of  mer- 
cury), it  is  important  to  keep  the  nervous  system  as  free  from  irritation 
as  possible.  For  the  kindly  operation  of  this  agent,  the  mind  as  well 
as  the  body  should  be  kept  tranquil. 


APPLICATION    TO    PARTICULAR    DISEASES. 

The  first  which  I  shall  notice  is  : 

1.  A  Disordered  Condition  of  the  Digestive  Organs. — This, 
though  not  known  by  any  particular  name  in  the  books  of  Nosology,  is 
one  which  you  will  very  frequently  meet  with  in  practice,  and  a  due 
understanding  of  its  nature  and  its  reciprocal  relations  with  the  state  of 
the  system  at  large,  will  enable  you  to  treat  successfully  many  diseases 
which  otherwise  might  prove  altogether  unmanageable. 

The  state  of  the  digestive  organs  will  vary  of  course  in  degree. 
Generally,  however,  it  is  characterized  by  the  following  symptoms : 
diminution  of  appetite  and  impaired  digestion  ;  sometimes,  however, 
the  appetite  will  not  be  materially  affected  or  it  may  be  even  excessive ; 
the  excretions  from  the  bowels  are  generally  deficient  in  quantity,  of  an 
unnatural  color  and  foetid.  The  tongue,  particularly  at  the  back  part, 
is  dry,  whitish,  or  furred.  This  is  most  apparent  in  the  morning.  The 
fur  extends  from  the  root  of  the  tongue  along  the  middle  to  the  tip, 
while  the  edges  remain  clean.  If  the  disease  progresses,  a  tenderness  is 
now  felt  in  the  epigastric  region  on  pressure,  and  the  patient  appears  to 


AI/I'KKATIVKS.  519 

breathe  more  by  tlic  ribs,  and  leas  by  the  diaphragm,  than  in  health. 
Along  with  these  symptoms,  the  mine  is  frequently  turbid. 

The  mind  is  also  frequently- irritable  and  desponding,  "  anxiety  and 

languor  are  expressed  in  the  countenance.  The  pulse  is  frequent  or 
feeble;    and   slight   exercise   produces   considerable    perspiration    and 

fatigue."  At  night  there  is  restlessness,  and  if  patients  sleep  they  awake 
unrefreshed  and  in  a  state  of  great  lassitude.  Now  this  state  of  things 
shows  not  merely  a  deranged  condition  of  the  digestive  organs,  but  also 
general  weakness  and  irritability  of  the  nervous  and  muscular  systems. 

This  condition  of  the  system  you  find  frequently  in  persons  who  are 
naturally  of  a  nervous  and  irritable  temperament.  You  see  it  also  in 
cases  of  local  irritation  implicating  the  digestive  organs,  or  of  a  general 
irritation  of  the  nervous  system,  as  in  cases  of  secondary  syphilis,  <fec. 
The  disorder  of  the  digestive  organs  is  then  caused  by  some  other  gene- 
ral or  local  irritation  in  the  system  ;  while  on  the  other  hand  this  very 
disorder  may  become  itself  the  cause  of  other  diseases — at  any  rate  be 
so  intimately  associated,  that  the  removal  of  the  one  will  generally  lead 
to  that  of  the  other. 

Treatment. — In  attempting  to  relieve  this  condition,  the  principal 
objects  are :  1.  To  improve  the  quality  and  increase  the  quantity  of  the 
secretions  from  the  liver  and  intestines.  2.  To  allay  the  irritability  and 
increase  the  tone  of  the  digestive  organs. 

To  accomplish  the  first  of  these  objects,  mercurial  alteratives  are  to  be 
used.  The  best  form  in  which  mercurv  can  be  <nven  js  that  of  the  blue 
pill,  or  the  plummer's  pill.  One  of  these  may  be  taken  every  other 
night.  Given  in  this  way  mercury  gently  stimulates  the  liver,  increases 
the  flow  of  bile,  and  at  the  same  time  corrects  its  quality  without  irritat- 
ing the  bowels. 

For  the  purpose  of  ascertaining  the  true  character  of  the  discharges, 
you  must  be  very  minute  in  your  inquiries;  you  are  otherwise  exceed- 
ingly liable  to  be  deceived.  For  the  purpose  of  clearing  out  the  bowels, 
occasionally  cathartics  are  necessary,  and  of  these  such  are  to  be  selected 
as  will  not  debilitate  either  the  system  or  the  intestines.  With  this  view 
it  may  be  well  to  combine  them  sometimes  with  tonics;  very. good  com- 
binations of  this  kind  may  be  made  with  rhubarb  and  calumba,  or  with 
senna  and  infusion  of  gentian. 

Syphilis. — In  both  forms  of  syphilis  some  of  the  agents  belona'iua'  to 
this  class  are  used,  and  I  shall  therefore  make  them  the  subject  of  a  few 
remarks.  In  the  primary  form  of  syphilis,  besides  the  local  remedies 
which  are  required,  recourse  is  generally  had  to  some  of  the  prepara- 
tions of  mercury.  Of  these  the  best  is  the  pil.  hydrargyri,  one  to  be 
given  night  and  morning.  Generally  speaking,  if  nothing  untoward 
occurs  in  the  case,  if  the  patient  submit  to  proper  regimen  and  diet,  in 


520  MATERIA   MEDICA   AND   THERAPEUTICS. 

the  course  of  three  or  four  weeks  chancres  will  heal  under  this  manage- 
ment; in  many  cases  in  much  shorter  time. 

In  the  secondary  forms  of  this  disease,  a  more  elaborate  course  is 
necessary.  Here  it  seems  requisite  that  the  system  should  be  subjected 
for  a  certain  length  of  time  to  the  slow  and  alterative  effects  of  a  mer- 
curial, to  eradicate  the  disease.  For  this  purpose  either  corrosive  subli- 
mate or  plummets  pill  is  generally  selected.  These  operate  mildly  on 
the  system,  and  can  be  continued  a  much  longer  time  than  most  of  the 
other  forms  of  this  metal,  without  producing  salivation  or  irritating  the 
bowels.  In  addition  to  this,  the  most  salutary  effects  are  obtained  from 
the  simultaneous  use  of  sarsaparilla  and  other  vegetable  alteratives.  Of 
these  the  best  are  the  decoction  of  the  ivoods  and  the  syrup  of  Sarsapa- 
rilla. These  preparations  improve  the  general  health,  and  have  a  very 
salutary  influence  in  correcting  the  bad  effects  of  mercury. 

Scrofula. — In  the  general  management  of  scrofula,  an  object  of  great 
importance  is  to  regulate  the  condition  of  the  digestive  organs.  This  is 
to  be  accomplished  by  the  occasional  use  of  alteratives ;  more  especially 
will  these  be  found  advantageous  when  the  tongue  is  foul,  and  other 
symptoms  of  gastric  and  intestinal  disorder  are  present.  Of  all  the  re- 
medies the  best  is  iodine.  As  an  internal  as  well  as  external  remedy  it 
has  been  used  with  the  greatest  advantage  and  success.  In  usino-  it  the 
general  precautions  already  laid  down  in  relation  to  it  are  to  be  carefully 
observed.  By  Dr.  Christian  gold  has  also  been  used  in  scrofulous  affec- 
tions with  the  greatest  success. 


INDIVIDUAL    ALTERATIVES. 

Mercury. — Of  the  general  history  of  this  article  I  have  already  given 
a  full  account.  Of  its  alterative  effects  in  inflammatory  complaints,  too, 
notice  has  been  taken.  At  present  I  shall  notice  it  simply  as  an  altera- 
tive given  in  minutedoses,  with  a  view  to  the  correction  and  eradication 
•  of  certain  forms  of  disease. 

Physiological  Effects. — When  given  in  minute  doses,  several  of  the 
preparations  of  mercury  produce  the  most  admirable  alterative  effects, 
acting  gently  on  the  liver,  stomach,  and  small  intestines,  and  augment- 
ing and  improving  the  secretions,  correcting  digestion,  obviating  habi- 
tual costiveness,  increasing  appetite,  and,  as  it  were,  renovating  the 
whole  system.  If  given  under  proper  restrictions,  all  this  may  be  done 
without  producing  any  very  marked  effect  in  the  way  of  evacuation,  &c, 
the  improved  general  health  being  the  only  evidence  of  their  activity. 
The  mercurials  given  as  alteratives  are  blue  pill,  pulv.  hydrargyri  c, 
creta,  calomel,  and  corrosive  sublimate.    Of  each  of  these  I  have  already 


AI/rEBATTOES.  521 

spoken,  and  shall  only  add  a  few  words  as  to  theil  respective  powers, 

modes  of  use,  and  value  as  alteratives. 

Blue  Pill. — This  is  perhaps  the  most  valuable  of  the  mercurial  altera- 
tives, mild  and  manageable,  yet  suffieiently  active.  Three,  grains  twice 
a  day  is  a  full  alterative  dose;  if  it  purge  or  produce  constitutional  irri- 
tation, or  show  a  tendency  even  towards  salivation,  it  should  be  omitted 
or  the  dose  much  diminished.  Combining  it  with  a  few  grains  of 
Dover  powder  will  often  prevent  these  b^d  effects,  and  sometimes  con- 
trol them  when  already  manifested. 

Hydrargyrum  cum  Greta. — This  is  a  milder  preparation  than  blue 
pill,  but  more  apt  to  produce  nausea,  and  less  reliable.  [It  is,  however, 
the  mercurial  for  children. — Ed.]  Dose  (for  adults)  5  to  8  grs.  twice  a 
day. 

Calomel. — This  is  the  favorite  mercurial  of  very  many  American 
practitioners;  as  an  alterative  inferior  to  blue  pill,  in  that  it  is  more  apt 
in  very  small  doses  to  irritate  the  bowels,  produce  purging,  and  some- 
times induce  a  general  constitutional  irritation.  Dose,  half  a  grain 
twice  a  day. 

Corrosive  Sublimate. — In  minute  doses  this  article  will  produce  the 
good  effects  of  a  mercurial  alterative,  but  it  is  more  apt  than  even  calo- 
mel to  produce  constitutional  irritation,  and  that  of  a  less  manageable 
kind.  It  has  an  advantage  over  either  of  the  other  preparations  of 
mercury  in  that  it  acts  more  decidedly  on  the  skin  and  the  urinary 
organs.  Opium  is  said  by  Bell  not  to  have  the  same  effect  in  counter- 
acting the  irritation  of  the  stomach  and  bowels  produced  by  corrosive 
sublimate,  as  when  like  effects  result  from  the  use  of  blue  pill  or  calo- 
mel.    Dose,  \  gr.  twice  a  day,  gradually  but  cautiously  increased. 

Plummets  Pill. — This  preparation  of  mercury  was  first  introduced 
into  practice  by  Dr.  Plummer,  and  from  him  derives  its  name.  It  is  a 
combination  of  calomel,  golden  sulphuret  of  antimony,  and  gum  guia- 
cum,  in  the  proportions  of  one  grain  of  each  of  the  two  first  and  two  of 
guiac.  This  pill,  though  not  a  great  deal  used,  is  a  most  excellent 
combination,  and  in  certain  cases  its  effects  are  unrivalled.  Its  peculi- 
arities, as  differing  from  simple  calomel,  are,  that  it  acts  more  on  the 
skin,  and  from  this  circumstance  is  less  likely  to  act  on  the  salivary 
glands,  or  to  produce  irritation  of  the  bowels.  It  is,  therefore,  an  excel- 
lent article  to  be  used  in  those  constitutions  which  are  too  readily  sali- 
vated by  mercury  or  too  liable  to  be  irritated  by  its  operation.  From 
its  action  on  the  skin,  it  is  peculiarly  beneficial  in  chronic  cutaneous 
affections,  and  in  the  secondary  form  of  syphilis,  particularly  where  the 
skin  is  affected.     The  dose  is  one  pill,  morning  and  evening. 


522  MATERIA   MEDIC  A   AND  THERAPEUTICS. 


IODINE. 

This  is  a  simple  substance,  and  is  one  of  the  numerous  and  valuable 
contributions  which  chemistry  has  made  within  a  few  years  to  the 
materia  medica.  It  was  accidentally  discovered  in  the  year  1812  by 
M.  Courtois,  a  manufacturer  of  saltpetre  in  Paris.  In  preparing  carbonate 
of  soda  from  the  ashes  of  sea  weeds  (kelp),  he  observed  that  the  residual 
liquor  corroded  metallic  vessels  powerfully.  On  investigating  the  cause 
of  this  he  found  tbat  sulphuric  acid  threw  down  a  dark-colored  matter, 
which,  by  the  application  of  heat,  was  converted  into  a  beautiful  violet 
vapor.  The  nature  and  properties  of  this  substance  were  soon  after- 
wards established  by  Gay-Lussac  and  Sir  Humprey  Davy,  and  the 
name  of  iodine  given  to  it. 

Iodine  is  found  extensively  distributed  both  in  the  organized  and 
unorganized  kingdoms  of  nature,  generally  in  combination  with  potas- 
sium or  sodium.  It  is  found  in  sea-water,  in  various  mineral  springs, 
and  sometimes  in  combination  with  some  of  the  metals,  such  as  silver, 
zinc,  and  lead.  It  exists  also  in  sponges,  in  the  oyster,  and  in  various 
marine  molluscous  animals.     In  most  of  the  sea  weeds  it  is  also  abundant. 

Mode  of  Prejxxration. — The  iodine  of  medicine  and  commerce  is 
obtained  from  kelp,  which  is  the  ashes  of  sea  weeds.  In  this  it  exists  in 
the  state  of  iodide  of  2^otassium,  or  sodium.  Kelp  contains  a  number  of 
ingredients,  such  as  the  chlorides  of  sodium  and  potassium,  carbonate  of 
soda,  sulphates  of  soda  and  potash,  &c.  It  is  used  by  the  soapmakers 
for  the  purpose  of  obtaining  the  carbonate  of  soda.  The  liquor  which 
remains  after  this  salt  is  separated,  is  acted  upon  by  sulphuric  acid  and 
the  binoxide  of  manganese.  When  subjected  to  heat  iodine  distils  over, 
and  is  collected  in  cool  glass  receivers.  It  is  then  washed  with  water, 
and  dried  between  folds  of  bibulous  paper. 

Properties. — Iodine  is  an  opaque,  soft,  friable  solid,  in  scales  of  a 
metallic  lustre,  and  of  a  greyish-black  color.  Its  specific  gravity  is 
4.948.  Its  odor  resembles  that  of  a  chlorine  ;  its  taste  is  hot  and  acrid. 
"When  rubbed  on  the  skin  it  stains  it  yellow.  At  120°  it  is  volatilized 
in  the  form  of  beautiful  violet-colored  vapors,  and  from  this  derives  its 
name,  from  the  Greek  tuSrig,  violet-colored.  These  vapors  being  col- 
lected, condense  again  into  new  flat  crystals.  In  water  it  is  very  spa- 
ringly soluble,  requiring  7000  parts  to  dissolve  it.  In  alcohol  and  ether 
it  is  readily  soluble;  with  starch  it  forms  a  compound  of  a  deep  blue 
color. 

Adulteration. — Although  iodine  is  generally  pure,  yet  it  sometimes 
has  been  found  adulterated  with  charcoal,  protoxide  of  iron,  coal,  plum- 
bago, <fec.     These  may  be  detected  by  heating  it  in  a  glass  tube  over  a 


ALTKRATIVKB.  523 

spirit-lamp  until  no  more  violet  vapors  escape.  II'  any  residuum  re- 
mains it  shows  the  adulteration.  The  amounl  of  adulteration  may 
be  ascertained  by  weighing  before  and  after  subjecting  to  heat. 


PREPARATIONS. 

In  Substance,  in  form  of  pill  with  liquorice,  each  pill  containing 
half  a  grain.     Not  now  used. 

Tincture. — Take  of  iodine  one  ounce,  of  alcohol  one  pint;  dissolve 
the  iodine.  U.  S.  Dose  from  ten  to  twenty  drops.  Thirty-five  drops 
contain  a  grain  of  iodine.  It  is  chiefly  used  externally,  sometimes  as  an 
injection  in  hydrocele. 

Ointment. — Take  of  iodine  3  i,  iodide  of  potassium  four  grains,  water 
six  minims,  lard  one  ounce.  Hub  the  iodine  and  iodide  together  in  the 
water  till  liquified,  then  add  the  lard.  The  object  of  the  hydriodate  and 
water  is  to  secure  the  equable  distribution  of  the  iodine  through  the 
lard.     Used  in  scrofulous  swellings,  &c. 

Liniment. — By  Dr.  Manson,  a  liniment  is  recommended  for  external 
application,  as  preferable  to  the  ointment.    It  is  made  in  the  following  way :. 
]J.  Tinct.  iodinii         .         •      3  i. 

Linim.  sap.  comp.  .      3  i.         M.. 

To  be  rubbed  on  the  part  once  or  twice  a  day.     Generally  the  skin  will 
not  bear  more  frequent  applications. 

COMPOUNDS    OF   IODINE, 

2.  Iodide  of  Potassium. — This  is  an  opaque,  white,  crystalline  salt.. 
It  has  an  acrid  and  saline  taste,  somewhat  resembling  that  of  common 
salt.  It  has  no  smell ;  it  is  soluble  in  about  two  thirds  of  its  own  weight 
of  water,  and  in  the  act  of  dissolving  is  converted  into  the  hydriodate  of 
potassa.  Its  aqueous  solution  is  capable  of  taking  up  a  large  quantity 
of  iodine,  and  then  becomes  an  ioduretted  hydriodate  of  potassa.  It  is 
also  readily  soluble  in  alcohol.  Iodide  of  potassium  contains  one  equiv. 
of  iodine  124,  and  one  of  potassium  40  =  164.  It  contains  no  water  of 
crystallization.  The  term  hydriodate  of  potash  generally  applied  to  this 
salt  is  incorrect. 

Mode  of  Preparation. — There  are  various  modes  of  preparing  this 
salt:  one  is  by  adding  iron  filings  to  a  mixture  of  iodine  and  distilled, 
water ;  this  is  to  be  subjected  to  the  action  of  heat  ;  a  solution  of  car- 
bonate of  potash  is  to  be  added  ;  this  is  to  be  filtered,  and  the  liquor  to 
be  evaporated — crystals  of  iodide  of  potassium  will  be  formed. 

In  the  first  part  of  this  process  an  iodide  of  iron  is  formed  in  solution. 
This  is  decomposed  by  the  carbonate  of  potash  ;  the  carbonate  of  iron 

34 


524  MATERIA   MEDICA  AND  THERAPEUTICS. 

is  precipitated,  and  the  iodide  of  potassium  held  in  solution.     By  evapo- 
ration it  is  obtained  in  the  form  of  crystals. 

Adulteration. — This  salt  is  said  to  be  extensively  adulterated.  The 
impurities  most  commonly  mixed  with  it  are  muriate  of  soda,  carbonate 
of  potash,  &c.  To  show  the  extent  of  these,  Pereira  states  that  he  ana- 
lysed a  sample  of  it  which  contained  seventy-seven  per  cent,  of  the  car- 
bonate of  potash.  Dr.  Christison  analysed  another  sample  which  con- 
tained 74.5  per  cent,  of  carbonate  of  potash,  10  of  water,  and  only  9.5 
of  iodide  of  potassium.  Dr.  O'Shaugnessy  analysed  another,  which 
contained  sixty -four  per  cent,  of  the  same  salt. — Lugol,.  p.  212. 

Tests. — 1.  Add  a  little  acetate  of  lead  to  a  solution  of  the  suspected 
specimen  ;  if  it  be  impure,  a  copious  white  precipitate  will  be  formed ; 
if  vure,  a  beautiful  golden  precipitate  will  be  formed,  perfectly  soluble  in 
hot  water,  and  which  crystallizes  on  cooling. — Lugol,  p.  214. 

2.  Another  test  is  to  add  a  solution  of  nitrate  of  silver  to  one  of  the 
suspected  article ;  if  impure,  a  white  precipitate  of  the  earbonate, 
chloride,  and  iodide  of  silver  subsides ;  filter,  and  when  dry,  project  the 
precipitate  into  ammonia,  which  dissolves  the  chloride  and  carbonate  of 
silver,  while  the  iodide  remains. — O'Shaugnessy  in  Lugol,  p.  213. 

Effects. — This  salt  produces  the  most  decided  effects  on  the  secre- 
tions, especially  on  the  urine.  It  has  very  remarkable  diuretic  powers. 
It  is  much  used  in  secondary  and  tertiary  syphilis,  and  in  the  sore  mouth 
of  syphilis  and  mercury.  Also  in  scrofulous  inflammation  of  the  eye, 
joints.  [In  the  tubercular  meningitis  of  children  it  is  the  only  remedy 
in  which  I  have  any  confidence. — Ed.]  It  seems  to  have  the  power  of 
eliminating  mereury  and  lead  from  the  system.  Both  metals  have  been, 
found  in  the  urine  after  the  free  use  of  the  hydriodate.  It  has  cured 
cases  of  mercurial  tremors  and  lead  paralysis.  It  seems  also  in  some 
cases  to  develop  the  effects  of  mercury  on  the  system.  It  also,  accord- 
ing to  Melsens,  increases  the  activity  of  some  of  the  mercurials,  when 
given  with  them. 

Mode  of  Administration. — The  ordinary  mode  of  giving  it  is  in  solu- 
tion with  simple  water  in  doses  of  from  five  to  ten  grains  to  an  adult, 
repeated  two  or  three  times  a  day.  By  some  it  has  been  given  in  much 
larger  doses. 

A  more  common  form  of  giving  it,  however,   is  with  iodine  in  solu- 
tion ;  a  solution  of  the  iodide  of  potassium  readily  dissolves  free  iodine, 
and  it  then  forms  what  is  the  ioduretted  iodide  of  potassium.     This  is 
the  preparation  so  highly  recommended  by  LugoL  which  he  considers  as 
possessing  advantages  over,  any  other.     It  is  made  as  follows  : 
fj,      Iodine     .         .         .         .      3  i. 
Iodide  of  potassium  .         .     ±)  ij. 
Distilled  water         .         .      3  vii.         M.J 
Of  this  Lugol  prescribes  six  drops  twice  a  day,  gradually  increasing 


AI/TEBATTVES. 


525 


the  dose  every  week  two  drops,  until  it  reaches  twenty  or  thirty  daily. 
It  is  given  in  half  a  glass  of  sweetened  water.  For  children  under  si  ven 
years  of  age,  two  drops  twice  a  day,  to  be  increased  graduall]  to  five 
drops  twice.  From  seven  to  fourteen  years,  he  seldom  exceeds  sixteen 
drops  daily. 

Ointment. — This  is  made  by  rubbing  up  3  i   of  iodide  of  potassium 


with    f  i  of  lard.     A  scruple  of  iodine  rul 


ip  with  this  makes  the 


No.  2. 

Xo.  3. 

grs.  iij 

grs.  iv 

grs.  vi 

grs.  vnj 

fi>j 

.      ftj 

ioduretted  ointment. 

Another  mode  of  external  application  is  by  solutions  of  various  strength. 
The  following  are  recommended  by  Lugo!  as  injections. 

No.  1. 
Tji     Iodine  grs.  ij 

Iodide  of  potass,  grs.  iv 
Dist.  water  g)j 

These  are  used  in  ozena,  fistulous  sinuses,  &c. 

Caustic  Iodine. — This  Lugol  prepares  thus  : 
]J    Iodine  .  3  i. 

Iod.  of  potas.         .      3  i. 

Dist.  water  .  3  ij     M. 

This  is  used  for  repressing  excessive  granulations,  &c. 

Baths. — This  is  one  of  the  favorite  forms  of  using  this  article  by  Lugol. 
The  following  is  a  tabular  view  of  the  mode  in  which  the  baths  are  pre- 
pared for  children  and  adults  : 


BATHS    FOR    CHILDREN. 


Age. 

Water. 

Iodine. 

Iodide  of  Potassium."^ 

4  to    7 

7  to  11 

11  to  14 

36  quarts. 
75       " 
125       " 

30  to  36    grs.  Troy. 
48  to  60-72     " 
72  to  96 

60  to  72   grs.  Troy. 
96-120-144  " 
144-192           " 

Age. 

Water. 

BATHS    FOR    ADULTS. 

Iodine.                         Iodide  of  Potassium. 

No.  1. 
"  2. 
"  3. 

200  quarts. 
240      " 
300      " 

2  to  2*  drs.  Troy. 

2-24-3 

3-H 

4  to  5  drs.  Troy. 
4-5-6         " 
6-7 

These  baths  are  generally  ordered  three  times  a  week.    Lugol,  p.  180. 

3.  Iodides  of  Mercury. — Of  these  there  are    two,  the  Protiodide 
and  the  Biniodide.     Protiodide  of  Mercury. — This  is  never  found  in 


526  MATERIA   MEDICA  AND   THERAPEUTICS. 

nature.  It  is  a  greenish  yellow  powder,  without  smell,  and  with  a  slight 
metallic  taste.  By  exposure  to  light  it  is  decomposed,  and  its  color 
changed.  It  is  insoluble  in  water  and  alcohol,  but  soluble  in  ether,  and 
slightly  so  in  an  aqueous  solution  of  the  iodide  of  potassium. 

Preparation. — It  is  prepared  by  rubbing  up  mercury  and  iodine  in 
equal  proportions,  with  the  addition  of  a  little  alcohol,  until  globules 
are  no  longer  visible.  The  alcohol  is  added  to  aid  the  solution  of  the 
iodine.     It  consists  of  one  equiv.  of  iodine  and  one  of  mercury.. 

Mode  of  Administration. — The  dose  of  this  is  from  one  to  two  grains 
daily  for  adults. 

Pill. — This  may  be  made  by  rubbing  up  of  the  protiodide  gr.  j.,  with 
extract  of  juniper  grs.  xii.,  and  liquorice,  q.  s. ;  divide  into  eight  pills. 
Of  these  two  may  be  taken,  night  and  morning,  gradually  increasing 
the  dose. 

Ether  of  the  Protiodide. — Made  by  dissolving  one  part  of  protiodide 
in  48  parts  of  sulphuric  ether.     Of  this  from  5  to  20  drops  may  be 
taken  in  distilled  water,  gradually  increasing. 
Ointment. — Protiodide   3_ss+  with  lard  fj^ 

Biniodide  of  Mercury. — Like  the  protiodide  this  is  not  found  in 
nature,  but  prepared  artificially.  It  is  a  powder  of  a  beautiful  scarlet 
color.  It  is  insoluble  in  water,  but  soluble  in  alcohol,  ether,  solutions  of 
iodide  of  potassium,  &c.  "  It  combines  with  other  alkaline  iodides  (as 
iodide  of  potassium)  forming  a  class  of  double  salts,  called  the  Hydrar- 
gyro-iodidesP — Pereira.  It  is  unaffected  by  the  atmosphere,  but  decom- 
posed by  light. 

Preparation. — It  may  be  prepared  by  rubbing  up  with  the  addition 
of  alcohol,  two  parts  of  iodine,  and  one  of  mercury,  until  globules  are 
no  longer  visible.     It  consists  of  two  eq.  of  iodine  and  one  of  mercury. 

Mode  of  Administration. — The  dose  is  ^  to  \  of  a  grain,  night  and 
morning. 

■Pill. — Made  the  same  as  the  preceding,  or  it  may  be  given  dissolved 
in  alcohol  or  ether. 

Ointment. — 15  grs.  to   §  i  of  lard. 

Effects  of  the  Iodides  of  Mercury. — Both  of  the  Iodides  of  mercury 
are  powerfully  irritant  and  caustic.  The  biniodide  is  nearly  as  caustic 
as  corrosive  sublimate.  The  protiodide  is  much  milder.  They  should 
both,  however,  be  used  with  caution.  Like  other  mercurials,  their  con- 
tinued use  causes  salivation.  Combining  the  properties  of  iodine  and 
mercury,  they  have  been  used  with  advantage  in  cases  of  syphilis 
occurring  in  scrofulous  constitutions. 

4.  Iodide  of  Starch. — This  is  prepared  by  rubbing  up  24  grs.  of 
iodine  with  a  little  water,  and  then  adding  gradually  §j.  of  starch,  the 
trituration  to  be  continued  until  the  compound  assumes  a  uniform  blue 


AI/I'KKATIVKS. 


Yll 


color.     It  is  th on  dried  with  a  gentle  beat,  so  ae  not  to  drive  off  tbe 
iodine,  and  to  be  kept  in  well-stopped  bottles. 

The  comhination  of  stare!)  renders  the  aetion  of  the  iodine  much 
milder.  3  ss  of  this  may  be  taken  three  times  a  day,  and  increa  ''I 
gradually.     Dr.  Buchanan  has  given  as  much  as  three  ounces  in  a  day. 

5.  Iodide  of  Iron, — This  is  an  "  opaque  iron-grey  crystalline  ma 
with  a  faint  metallic  lustre,"  and  an  astringent  taste.     It  is  volatile,  very 
deliquescent,  and  very  soluble  both  in  water  and  alcohol.      By  exposure 
to  the  air  it  attracts  oxygen,  and  "  forms  sesquioxide  of  iron." 

Preparation, — Made  by  mixing  certain  proportions  of  iodine,  water, 
and  pure  iron  filings,  and  subjecting  them  to  heat  in  a  sand  bath. 
When  it  has  acquired  a  greenish  color  pour  off  the  liquor,  and  wash 
the  residue  with  boiling  water.  The  liquors  are  then  to  be  evaporated, 
and  the  salt  dried.  It  contains  one  eq.  of  iodine,  and  one  eq.  of  iron. 
This  preparation  combines  the  tonic  effects  of  iron  with  the  peculiar 
effects  of  the  iodine,  and  is  accordingly  used  in  all  cases  where  this  kind 
of  combination  is  required,  as  in  chlorosis,  asthenic  dropsy,  chronic  vis- 
ceral engorgements,  &c,  &e.  Fom  its  great  solubility,  it  acts  writh 
great  power  on  the  system. 

Dose. — Three  to  eight  grains,  two  or  three  times  a  day,  in  pill  or 
solution. 

6.  Iodide  of  Arsenicum. — This  is  a  solid,  of  an  orange  red  color, 
volatile  and  soluble  in  water.  It  is  prepared  by  gently  heating  in  a 
tubulated  retort  placed  in  a  sand-bath,  a  mixture  of  one  part  of  finely- 
pulverized  arsenic  with  five  parts  -of  iodine.  The  iodide  is  afterwards 
to  be  sublimed  to  separate  the  excess  of  arsenic.  It  consists  of  1J  eq. 
of  iodine,  and  one  eq.  of  arsenic.     (Pereira). 

Mode  of  Administration. — Internally  it  has  beeu  used  by  Dr.  Thom- 
son of  London,  with  success  in  cases  of  lepra  and  impetico.  He  began 
with  Tl0-  of  a  gr.,  three  times  a  day,  increased  to  ^  of  a  gr.  Beyond 
this,  its  use  is  dangerous. 

Ointment. — Iodide  of  arsenicum,  grs.  iij  ;  lard,  3  j.  Used  by  Biett 
in  phagedenic  tubercular  disease  of  the  skin.] 

7.  Iodide  of  Lead. — This  is  a  powder  of  a  beautiful  yellow  eolor, 
partially  soluble  in  acetic  acid  and  in  alcohol.  In  cold  water  it  is  inso- 
luble, but  perfectly  so  in  boiling  water,  from  which  it  separates  as  the 
solution  cools  in  fine  brilliant  scales.  It  consists  of  one  eq.  of  iodine 
and  one  eq.  of  lead.  It  is  prepared  by  the  reciprocal  actions  of  solu- 
tions of  iodide  of  potassium  and  acetate  of  lead.  Iodide  of  lead  is  pre- 
cipitated and  acetate  of  potash  in  solution.  The  precipitate  to  be 
washed  and  dried.  Perfect  solubility  in  boiling  water  is  the  test  of  its 
purity. 


528  MATERIA   MEDICA   AND   THERAPEUTICS. 

Effects. — In  its  local  action  on  the  skin  iodide  of  lead  does  not 
appear  to  be  irritant;  internally  it  is  mild,  though  in  some  cases  it  has 
produced  irritation  of  the  stomach  and  constipation.  Its  general  action 
is  alterative,  like  iodine.  It  is  used  internally  and  externally  in  cases 
of  glandular  enlargement.     Less  active  than  iodine. 

Mode  of  Administration. — One-fourth  to  half  a  grain  twice  a  day, 
gradually  increased.  Ten  grains  may  be  given  without  inconvenience. 
(O'Shaugnessy  in  Lugol.) 

Ointment. —  3  j  to   3  j  of  lead. 

8.  Iodide  of  Sulphur. — This  is  a  compound  of  a  massy  appearance7 
of  a  dark  color,  and  a  lamellated  structure.  It  is  prepared  by  heating 
gently  four  parts  of  sulphur  with  one  of  iodine.  Part  of  the  iodine 
volatilizes,  while  the  remainder  unites  with  the  sulphur.     (Pereira.) 

It  has  the  peculiar  smell  of  iodine,  and  stains  the  skin  as  it  does.  If 
it  be  boiled  in  water  the  iodine  volatilizes  with  the  steam,  and  the  sul- 
phur is  deposited  nearly  pure.  It  consists  of  one  eq.  of  iodine,  and  one 
eq.  of  sulphur. 

Mode  of  Administration. — Not  used  internally,  only  as  an  external 
application  in  the  proportion  of  about  3j  to   §"j  of  lard. 

9.  Iodide  of  Zinc. — This  is  a  white  crystalline  salt  in  needles,  very 
deliquescent,  and  very  soluble  in  water.  It  has  a  disagreeable  and 
styptic  taste.  It  is  prepared  by  the  joint  action  of  solutions  of  sulphate 
of  zinc  and  iodide  of  baryta,  filtering  and  evaporating  to  dryness,  or  by 
subjecting  to  heat  and  subliming  twenty  parts  of  zinc  with  110  iodine. 

I  am  not  aware  that  this  has  been  used  internally.  It  is  recom- 
mended as  an  external  application  for  discussing  tumors  by  Dr.  Ure, 
who  proposes  it  as  a  substitute  for  the  ointment  of  the  iodide  of  potas- 
sium : 

Ointment  lod. —  3  j  to  3  j  lard;  a  drachm  of  this  to  be  rubbed  on 
the  tumor  twice  a  day. 

10.  Iodide  of  Gold. — Of  a  greenish-yellow  color,  insoluble  in  cold, 
but  slightly  so  in  boiling  water.  Heated  in  a  crucible,  iodine  vapors 
are  given  off,  and  metallic  gold  is  left. 

It  has  been  used  internally  in  venereal  affections  in  doses  of  from  TL 
to  -jL-  of  a  grain.     (Pereira.) 

Effects  and  Uses  of  Iodine. — When  taken  in  small  and  repeated 
doses,  iodine  operates  like  the  other  agents  belonging  to  this  class  of 
alteratives.  It  alleviates  certain  diseased  conditions  without  producing 
any  sensible  effect  on  the  system.  In  this  way  it  may  be  taken  for 
weeks  and  even  months.  During  this  time  the  functions  of  the  diges- 
tive organs   are   generally  improved,  and   the   appetite   is   frequently 


ALTERATIVES.  •'320 

greatly  increased.  Lugo!  states  that  ;it  the  Hospital  of  St.  IVouis,  where 
this "remedy  was  extensively  used,  this  effeel  was  so  decided  thai  the 
ordinary  hospital  allowance  was  not  sufficient  to  satisfy  the  pa 
In  many  cases  tin's  is  the  only  effect  produced.  In  other  cases,  from  its 
genera]  operation  on  the  secreting  and  absorbing  system,  itf  effeel  .-ire 
more  visible.  Sometimes  it  proves  powerfully  diuretic,  while,  in  others 
this  is  not  observed,  and  sometimes  it  acts  as  emmcriagogu  ,  while  at 
others,  again,  it  produces  no  effect  on  the  uterine  organs.  On  the 
glandular  system  effects  of  a  peculiar  and  striking  character  have  occa- 
sionally been  noticed.  These  are  a  diminution  and  wasting  of  the 
mammce  in  females,  and  of  the  testicle.?  in  males.  Occasionally  saliva- 
tion is  produced  by  it.  On  the  adipose  tissue  its  effect  varies;  ome- 
times  it  occasions  emaciation,  while  in  others  a  contrary  effect  is  pro- 
duced. According  to  Lugol  it  always  increases  the  growth  and  size  of 
the  body. 

There  can  be  no  question  that  iodine  acts  on  the  whole  system  of 
capillary  vessels,  exciting  under  different  conditions  of  the  system 
sometimes  one  organ  and  sometimes  another. 

If  the  use  of  iodine  be  persisted  in  too  long,  it  affects  the  system  like 
a  poison.  In  some  cases  the  stomach  and  bowels  become  disordered 
there  is  vomiting  and  purging  accompanied  with  general  excitement  and 
disturbance  of  the  system.  In  other  cases  the  nervous  system  is  assailed 
by  tremors ;  general  prostration,  loss  of  appetite,  and  emaciation  are  the 
prominent  symptoms. 

DISEASES    IN    WHICH    IODINE    HAS    BEEN    USED. 

1.  Bronchocele. — This  was  the  disease  in  which  iodine  was  first 
used,  and  it  is  to  Dr.  Coindet,  of  Geneva,  that  we  are  indebted  for  its 
first  introduction  into  practice.  It  was  originally  suggested  to  this  phy- 
sician by  his  reflecting  on  the  fact  that  iodine  has  been  discovered  in 
the  sponge,  an  article  which  in  the  form  of  burnt  sponge  has  long  held 
a  high  reputation  among  the  vulgar  as  well  as  among  physicians,  as  a 
cure  for  bronchocele,  and  from  this  circumstance  he  was  induced  to  sus- 
pect that  the  virtues  of  the  sponge  depended  upon  the  presence  of 
iodine.*  Living  in  a  district  of  country  where  this  disease  prevails  ex- 
tensively, he  had  immediate  opportunities  of  putting  his  suggestions  to 
the  test  of  actual  experiment,  and  was  speedily  gratified  by  obtaining  the 
most  decisive  proofs  of  its  efficacy.  Immediately  on  the  annunciation 
of  the  beneficial  effects  of  iodine  in  this  disease,  experiments  were 
made  with  it  by  practitioners  in  various  parts  of  Europe,  all  of  whom 
concurred  in  celebrating  its  virtues.     In  this  country  it  was  tried,  and 

*  Memoire  de  M.  Coindet  in  Bayle's  His.  vol.  i.  p.  6. 


530  MATEEIA   MEDICA   AND   THERAPEUTICS. 

with  equal  success.  From  the  extensive  experience  which  we  have  thus 
had  of  this  remedy,  we  are  now  able  to  form  an  impartial  opinion  in 
relation  to  its  real  virtues.  Although  not  a  specific  in  this  disease,  as  it 
was  first  supposed,  yet  it  exercises  a  wonderful  control  over  it,  and  such 
as  no  other  medicine  is  capable  of.  Bayle  has  made  a  summary  of  the 
cases  treated  by  a  number  of  physicians,  and  as  the  result  he  states  that 
of  354 — there  were  264  cases  of  goitre  cured.* 

2.  Scrofula. — This  is  another  disease  in  which  this  remedy  has 
been  peculiarly  successful,  and  it  is  to  Dr.  Coindet  that  we  are  also 
indebted  for  suggesting  its  use  here.f  It  has  been  used  by  different 
physicians,  but  by  none  so  extensively  or  successfully  as  Lugol  of  Paris. 
It  appears  that  during  seventeen  months,  109  scrofulous  patients  were 
treated  with  iodine  alone,  at  the  Hospital  St.  Louis,  of  which  61  were 
males  and  48  females.  Of  these,  39  (29  males,  10  females)  were  still 
under  treatment  at  the  time  of  the  report;  that  30  (17  males,  13  fe- 
males) had  left  the  Hospital  much  improved  ;  that  in  four  cases  (2  males 
and  2  females)  the  treatment  was  ineffectual ;  and  that  36  (13  males 
and  23  females)  were  completely  cured.J  By  Lugol  the  iodine  is  used 
both  internally  and  externally,  and,  what  is  new  in  his  practice,  in  the 
form  of  baths,  to  which  he  attaches  the  greatest  efficacy. 

3.  Chronic  Enlargements  of  the  Viscera. — In  the  enlargements  of 
the  liver,  spleen,  mammae,  testicles,  and  ovaria,  iodine  has  been  used 
with  great  advantage. 

4.  Dropsies. — In  some  cases  of  ascites,  I  have  used  iodine  with  the 
happiest  effects.  By  Dr.  Thomson  three  cases  of  ovarian  dropsy  are 
stated  to  have  been  cured  by  the  internal  and  external  use  of  this 
agent.§ 

5.  As  an  emmenagogue,  iodine  is  particularly  spoken  of  by  Coindet 
and  others.  In  several  cases,  I  have  witnessed  its  effects  on  the  uterine 
organs.  Magendie  states  that  he  gave  it  in  a  case  represented  to  be  one 
of  suppressed  menstruation,  and  in  three  weeks  abortion  was  the  result.|| 

6.  Nervous  Diseases. — In  eleven  cases  of  chorea  it  was  used  by  Dr. 
Munson  with  success.  By  the  same  physician  it  was  also  used  with 
advantage  in  cases  of  paralysis,  arising  from  tumors  or  fluids  pressing 
on  the  brain  or  spinal  marrow,  or  from  morbid  thickening  of  the  invest- 
ing membrane  of  the  cord  itself. 

*  Therapeutique,  vol.  i.  p.  194.  f  Ibid.,  p.  25. 

X  Lugol  on  Iodine.     Translated  by  O'Shaugnessy,  p.  8. 
§  Mat.  Med.  vol.  i.,  p.  346. 
|  Bayle,  pp.  10,  195. 


ALTERATIVES.  521 

7.  Diseases  of  the  Skin. — Where,  as  is  very  common,  diseases  of 
the  skin  are  connected  with,  if  not  dependent  on,  scrofula,  iodine  may 
be  used  with  the  greatest  advantage.  Chronic  cases,  of  eczema  in  par- 
ticular, yield  to  it  promptly. 

8.  Lastly.  In  syphilitic  diseases  it  has  recently  been  need,  and  with 
apparent  advantage  ;  also  to  arrest  salivation. 

Gold. — This  metal  is  found  in  almost  every  part  of  the  world,  and 
only  in  the  metallic  state,  either  alone  or  alloyed  with  other  metals.  It 
is  of  an  orange  yellow  color,  and  exceeds  all  other  metals  in  malleability 
and  ductility.  Exposure  to  air  and  moisture  for  any  length  of  time  pro- 
duces no  change  in  it.  It  is  not  oxydized  or  dissolved  by  any  of  the 
pure  acids.  Its  only  solvents  are  chlorine  and  nitro-muriatic  acid. 
According  to  Sir  II.  Davy,  the  agent  in  both  cases  is  the  chlorine. 

Physiological  Effects. — When  taken  in  small  and  continued  doses,  this 
article  operates  like  most  of  those  belonging  to  this  class.  It  gently 
stimulates  the  digestive  organs  and  improves  the  appetite,  at  the  same 
time  that  it  moderately  excites  the  pulse.  The  only,  marked  and  sensi- 
ble effect,  however,  which  is  produced,  is  that  of  increasing  perspiration 
and  the  flow  of  urine.  The  latter  it  does  uniformly  and  to  a  very  de- 
cided extent.*  If  it  be  given  in  larger  quantities,  it  produces  a  general 
febrile  excitement  of  the  system,  accompanied  with  a  universal  heat  of 
the  skin.  The  bowels  are  generally  constipated.  In  some  cases  there  is 
dryness  of  the  mouth  and  throat.  The  gums  become  affected,  and  sali- 
vation ensues.  According  to  M.  Niel,  the  salivation  produced  by  gold 
differs  from  that  of  mercury  in  many  important  respects.  It  is  always 
mild — never  producing  the  severe  irritation  and  inflammation  of  the 
gums  and  mouth  which  so  frequently  accompany  mercurial  salivation. 
It  is  less  protracted  in  its  duration,  and  is  unattended  by  the  disgusting 
fcetor  of  mercurial  salivation. 


PREPARATIONS    OF    GOLD. 

1.  In  the  state  of  Metal. — By  Chrestien  and  others  it  has  been 
used,  and  is  said  to  produce  the  same  effects  as  the  salts  of  gold. 

This  is  supposed  to  be  the  mildest  of  the  preparations  of  gold,  but 
equally  efficacious,  though  more  slow  in  producing  its  effects. 

It  is  given  in  doses  of  from  a  quarter  to  one  grain  three  or  four  times 
a  day  in  pill  or  powder. 

2.  Chloride  of  Gold. — This  is  prepared  by  dissolving  by  the  aid  of 

*  Niel,  p.  59.     Delafield  Med.  Rep.  v.  ix.,  p.  182. 


632  MATERIA   MEDICA   AND   THERAPEUTICS. 

lieat,  one  part  of  gold  in  three  parts  of  nitro-hydrochloric  acid.*  The 
solution  is  to  be  evaporated  until  vapors  of  chlorine  begin  to  be  per- 
ceived, and  then  suffered  to  crystallize. 

This  salt  is  in  small  crystalline  needles,  of  an  orange  red  color,  with- 
out smell,  and  of  a  strong,  styptic,  acid  taste.  It  is  readily  soluble  in 
Water,  alcohol,  and  ether.  It  consists  of  1  eq.  of  gold  and  3  eq.  of  chlo- 
rine.    It  is,  therefore,  a  terchloride  of  gold. 

Effects. — This  is  a  very  active  preparation,  resembling  somewhat  cor- 
rosive sublimate.  It  requires,  therefore,  to  be  given  in  small  quantities 
and  with  caution. 

Dose. — One  twentieth  to  one  eighth  of  a  grain  once  or  twice  a  day, 
made  up  into  pills  with  starch,  or  in  solution  with  distilled  water. 

3.  Chloride  of  Gold  and  Sodium. — This  is  prepared  by  dissolving 
eighty-five  parts  of  chloride  of  gold  to  sixteen  of  chloride  of  sodium  in 
distilled  water.  The  solution  is  to  be  evaporated  by  a  gentle  heat  until 
a  pellicle  forms,  and  then  set  by  to  crystallize. —  (Pereira.) 

It  consists  of  large  quadrangular  prisms,  of  a  beautiful  yellow  color. 
They  are  soluble  in  water,  and  consist  of  1  eq.  of  chloride  of  gold,  and 
1  of  chloride  of  sodium,  and  4  of  water. 

This  is  a  milder  preparation  of  gold  than  the  preceding.  It  is,  also, 
less  expensive,  and  is,  therefore,  the  most  used  of  any  of  the  preparations 
of  this  metal. 

It  is  given  in  the  same  doses  as  the  chloride. 

4.  Oxidb  of  Gold. — "  This  is  prepared  by  boiling  four  parts  of  calcin- 
ed magnesia  with  one  part  of  chloride  of  gold  and  forty  parts  of  water. 
Then  wash,  first  with  water,  to  remove  the  chloride  of  magnesium, 
afterwards  with  dilute  nitric  acid,  to  dissolve  the  excess  of  magnesia." — - 
(Pereira.) 

The  oxide  of  gold  is  of  a  brown  color,  in  the  form  of  hydrate,  reddish 
yellow,  insoluble  in  water,  but  soluble  in  hydrochloric  acid.  It  consists 
of  3  eq.  oxygen  and  1  eq.  of  gold.     It  is,  therefore,  a  teroxide  of  gold. 

It  is  given  in  pills  in  doses  of  one  tenth  of  a  grain  to  one  grain  a 
day. 

With  regard  to  the  use  of  the  salts  of  gold,  there  are  certain  objec- 
tions to  their  internal  use.  In  the  first  place  they  are  very  active,  and 
sometimes  cause  a  good  deal  of  local  irritation  in  the  stomach.  In  the 
second  place,  they  are  very  readily  decomposed  by  a  great  variety  of 
substances,  and  thus  lose  their  activity. 

*  Aqua  Regia,-~Qiie  part  of  nitric  and  two  of  hydrochloric  acid. 


Al.TKKATIVKH.  539 


DMHSASEB    IM    WHICH    GOLD    IH    i;skh. 

1.  .Syphilis. — This  is  the  disease  in  which  gold  was  specially  recom- 
mended by  .Dr.  Clirestien,  as  a  substitute  for  mercury.  This  interesting 
fact  was  announced  in  a  work  which  appeared  in  the  year  1811,*  in 
which  a  number  of  cases  are  reported  in  which  it  proved  successful, 
According  to  the  representations  contained  in  this  work,  it  would 
appear  that  gold  is  capable  of  curing  syphilis  under  all  its  forms,  and 
that  in  its  general  operation  on  the  system  it  possesses  many  advantages 
over  mercury.  It  is  efficacious,  yet  gentle.  It  may  be  administered 
with  perfect  safety  at  any  season  of  the  year,  and  under  any  complica- 
tion of  the  disease.  Persons  of  either  sex  may  be  put  upon  it  with 
equal  safety.  The  only  precaution  which  he  enjoins  during  its  use,  is 
the  observance  of  strict  temperance.  In  other  respects,  the  patient  is 
not  required  to  change  his  accustomed  mode  of  living.  Very  shortly 
after  the  appearance  of  this  work  our  distinguished  countryman,  Dr. 
Samuel  L.  Mitchill,  made  the  medical  public  in  this  country  acquainted 
with  its  contents,  and  immediately  commenced  a  series  of  experiments 
with  gold  in  the  New  York  Hospital.  The  result  of  his  experience  is 
contained  in  the  following  letter  to  the  late  Dr.  Dyckman  :  "  The  efficacy 
of  the  medicine  has  been  tried  year  after  year  in  the  New  York  Hospital. 
My  practice  with  it  there  has  been  witnessed  by  all  the  attendants  of 
the  wards.  It  possesses  admirable  virtues  against  syphilis.  Without 
presuming  to  affirm  that  it  is  capable  of  eradicating  the  distemper  in 
every  instance,  my  opinion,  upon  the  whole,  is  that  the  muriate  of  gold 
will  effect  all  that  is  achieved  by  the  muriate  of  quicksilver,  with  incom- 
parably less  inconvenience  to  the  patient.  He  gets  well  under  the 
operation  of  the  former  without  the  hazard  of  a  sore  mouth  or  a 
salivation,  and  with  very  little  wear  and  tear  of  constitution.  I  con- 
sider the  introduction  of  this  preparation  into  common  use  as  one 
of  the  greatest  improvements  in  modern  medicine ;  and  I  wish  it  was 
already  as  universal  as  the  malady  it  is  intended  to  remove.  The 
muriate  of  gold  is  found  to  increase  the  quantity  of  urine,  in  many 
instances  to  such  a  degree  that  it  ought  to  be  ranked  among  the 
diuretics  of  the  materia  medica."f  In  1812,  Dr.  J.  C.  Cheesman,  of  this 
city,  published  an  inaugural  dissertation,  in  wrhich  are  detailed  a  number 
of  cases  of  primary  syphilis  which  had  been  successfully  treated  by  this 
remedy  in  the  New  York  Hospital.J  In  1816  its  use  was  again  revived 
in  that  institution,  and  in  1817  a  report  was  published  by  Drs.  J.  K, 

*  De  la  Methode  Iatraleptique,  etc.,  par  J.  A.  Chrestien,  Paris,  1S11. 
f  Duncan's  Edinburgh  Dispensatory,  edited  by  Dycknian. 
%  New  York  Med.  Rep.,  vol.  six.  p.  180. 


534  MATERIA   MEDIC  A   AND   THERAPEUTICS. 

Rodgers  and  Delafield,  containing  an  account  of  81  cases  of  syphilis 
successfully  treated  by  the  same  remedy.  The  results  of  all  this  experi- 
ence at  the  New  York  Hospital  seem  to  be  then  : 

1.  That  in  the  treatment  of  primary  syphilis,  the  muriate  of  gold 
possesses  powers  fully  equal  to  those  of  mercury. 

2.  In  cases  cured  by  gold,  secondary  symptoms  did  not  supervene 
more  frequently  than  in  cases  which  have  been  cured  by  mercury. 

3.  In  secondary  syphilis,  gold  is  not  to  be  depended  upon  for  a  radical 
cure. 

Never  having  used  the  gold  myself  I  can  add  nothing  from  my  own 
experience  in  relation  to  it.  Although  not  used  much  at  present,  there 
are  still  physicians  in  our  city  who  are  in  the  habit  of  using  it,  and 
who  rely  upon  it  with  great  confidence. 

2.  Scrofulous  Affections. — Several  cases  of  this  kind  are  recorded 
by  Chrestien  as  having  been  cured  by  the  use  of  gold.*  Similar  cases 
have  also  been  reported  by  Niel. 

3.  Goitre. — By  both  Chrestien  and  Niel  cases  of  this  disease  are 
stated  to  have  yielded  under  the  use  of  this  remedy. 

4.  Dropsy. — From  the  decided  effects  of  gold  in  promoting  the  flow 
of  urine,  it  has  been  used  in  this  form  of  disease,  and  in  some  cases  it 
has  proved  successful.  The  late  Dr.  J.  Low,  of  Albany,  rejates  that  he 
tried  it  in  a  well  marked  case  of  ascites,  and  that  it  "  was  attended  by 
the  best  effects." 

[Oleum  Jecoris  Aselli  ,(CW  Liver  Oil.) — This  oil,  which  has  of 
late  years  gained  so  much  celebrity,  is  obtained  from  the  livers  of  vari- 
ous species  of  the  genus  Gadus,  especially  the  G.  Morrhua,  G.  Callarias, 
G.  Molva,  G.  Carbonarius.  It  is,  however,  probable  that  much  of  the 
oil  of  commerce  is  obtained  from  other  species,  or  indeed  from  species 
of  other  genera,  especially  the  Raia.  Three  species  of  oil  are  spoken  of, 
the  brown,  the  light  brown,  and  the  pale  or  yelloiv.  These  varieties  do 
not  depend  upon  the  species  of  cod  used,  but  upon  the  manner  in  which 
the  oil  is  obtained.  If  the  livers  are,  as  is  often  done,  thrown  into  a  tub 
with  a  perforated  bottom,  and  the  oil  which  runs  spontaneously  from 
them  promptly  collected  and  skimmed  or  strained,  it  is  pale ;  if  this  is 
allowed  to  remain  on  the  livers  till  they  become  putrid,  or  the  oil  is 
kept  in  a  wet  place,  if  due  care  is  not  taken  in  its  preparation  or  preser- 
vation, it  takes  a  darker  hue,  and  then  we  have  the  light  brown  oil. 
When,  after  the  pale  oil  has  run  off,  the  livers  are  boiled  in  iron  pots  for 

*  Methode  Iatraleptique. 


ALTERATIVES,  585 

from  twelve  to  twenty  hoars,  an  oil  is  obtained  of  a  'lurk  color,  rani  un- 
pleasant smell,  and  nauseous  taste  ;  this  is  tin-  brown  oil. 

Physical  Properties  of  Pule  Oil. — Fluid  at  ordinary  temperatures,  of 
a  bright  yellow  or  golden  color;  fishy  taste,  more  or  less  strong,  and  a 
smell  resembling  in  the  very  pale  qualities  that  of  freshly-boiled  cod,  but 
stronger.  Between  this  and  the  dark  brown  oil  there  is  every  shad'-,  of 
difference  in  color,  and  every  degree  of  rank  iishiness  in  the  taste  and 
smell.  The  pale  oils  have  generally  the  consistence  of  olive  oil,  and  are 
clear  ;  the  browner  are  thicker  and  more  or  less  turbid.  There  is  a  very 
great  difference  of  opinion  as  to  the  relative  merits  of  the  varieties  of 
oil.  The  Germans,  who  of  late  years  have  nsed  the  oil  most  freely,  pre- 
fer the  darker  kinds;  in  England  and  in  this  country,  the  paler  are  pre- 
ferred ;  and  it  is  confidently  asserted  that  the  oil  can  be  deprived  of  its 
most  offensive  properties  of  smell  and  taste,  and  yet  retain  its  remedial 
powers. 

Chemical  Analysis. — Cod  liver  oil  is  composed  of  margaric  and  oleic 
acids,  biliary  matter,  iodine,  phosphorus,  butyric  and  acetic  acid,  a  pecu- 
liar substance  discovered  by  De  Jongh,  and  by  him  called  Gaduine,  with 
several  organic  salts  and  acids  in  small  proportion.  These  ingredients 
exist  in  the  varieties  of  oil  in  varying  proportions.  The  pale  oils  con- 
tain most  iodine  and  inorganic  salts,  while  the  darker  sorts  have  most 
biliary  matter,  butyric,  and  acetic  acid. 

Effects  on  the  System. — Cod  liver  oil  does  not  produce  marked  sensi- 
ble effects  with  any  constancy.  Sometimes  it  offends  the  stomach, 
causing  nausea  or  even  vomiting.  In  some  rather  rare  cases,  it  purges ; 
in  a  few  cases  it  has  increased  the  flow  of  urine,  or  the  perspiration,  but 
generally  it  affects,  none  of  the  secretions.  • 

No  effect  can  be  expected  from  it,  as  a  general  rule,  unless  its  use  be 
continued  for  a  considerable  time  ;  say  on  an  average  three  to  four 
months. 

Use  in  Disease. — The  use  of  cod  liver  oil,  though  now  a  fashion,  is 
by  no  means  a  strictly  new  thing.  The  oil  was  used  nearly  a  century 
ago  by  Percival  and  Bardsley,  in  England  ;  and  in  Germany  it  has  been 
a  popular  remedy  from  time  immemorial.  The  attention  of  the  profes- 
sion was  again  directed  to  it  about  thirty  years  ago,  by  several  German 
physicians,  who  published  in  rapid  succession  histories  of  cures  effected 
by  cod  liver  oil  in  rheumatism,  gout,  scrofula  in  all  its  varieties,  and 
finally  in  phthisis  pulmonalis.  From  Germany  the  practice  passed  into 
France  and  England,  and  has  been  adopted  in  both  countries.  In  Eng- 
land the  oil  has  been  highly  appreciated  by  Dr.  J.  Hughes  Bennet,  and 
most  extravagantly  lauded  by  Dr.  Williams.  But  amid  all  the  lauda- 
tion and  enthusiasm  which  the  new  remedy  has  excited,  not  a  few  have 
declared  it  of  little  value,  and  a  still  greater  number  have  confessed  that 
enlarged  experience  has   very   much    moderated    their  expectations  of 


536  MATERIA    MEDICA    AND   THERAPEUTICS. 

benefit  from  it.  The  disease  in  which  it  was  first  used  by  Schenk,  in 
Germany,  was  rheumatism.  He  reported  a  large  number  of  cases  of 
chronic  inflammatory  rheumatism,  in  which  its  use  produced  the  best 
effects.  Subsequent  observations  have,  to  a  certain  extent,  confirmed 
the  views  of  Schenk.  The  forms  of  rheumatism  in  which  it  was  first 
likely  to  do  good  are  those  in  broken-down  habits,  those  depending  on 
imperfect  digestion,  and  those  occurring  in  scrofulous  subjects ;  and 
where  in  old  people  the  tendons  and  muscles  are  rigid,  the  joints  stiff,  &c. 

Gout. — In  this  disease  the  oil  has  been  given  a  good  deal,  but  not 
with  the  same  amount  of  success  as  in  rheumatism. 

Scrofula. —  The  Scrofulous  Diathesis. — Here  it  is  that  cod  liver  oil 
has  gained  most  of  its  reputation,  and  by  many  it  is  still  considered 
almost  a  specific. 

Now  that  the  steady  and  pretty  long-continued  use  of  the  remedy  has, 
in  very  many  cases,  produced  the  most  admirable  effects,  cannot  be 
doubted,  and  it  seems  to  do  this  chiefly  by  its  influence  in  correcting 
various  derangements  of  secondary  assimilation.  Whether  this  change 
is  effected  by  suppl)Ting  to  the  digestive  organs  a  material  with  which 
they  can  repair  the  various  results  of  defective  nutrition,  or  whether  it  is 
by  giving  to  the  digestive  function  power  to  perfect  the  assimilation  of 
food  taken,  is  by  no  means  easy  to  say.  Be  this  as  it  may,  in  very 
many  of  these  cases,  whether  of  caries,  of  scrofulous  ophthalmia,  of  tabes 
mesenterica,  or  tubercular  peritonitis,  or  of  various  diseases  of  the  skin, 
connected  more  or  less  closely  with  scrofula,  as  eczema,  herpes,  and 
some  forms  of  impetigo,  it  has  produced  excellent  effects.  Under  its 
use  the  constitution  in  general  seems  to  gain  vigor,  the  complexion  is 
clearer,  the  eye  more  lively,  the  mind  cheerful,  the  strength  improved, 
and  a  remarkable  tendency  to  the  deposit  of  fat  shows  itself.  While 
the  change  in  the  natural  functions  is  going  on,  as  manifested  by  the 
general  improvement  in  the  aspect  of  the  patient,  the  disease  frequently 
gives  way  ;  chronic  ulcerations  heal,  enlarged  glands  diminish  in  size, 
chronic  eruptions  disappear,  the  scrofulous  ophthalmia  is  relieved. 

Phthisis  Pulmonalis. — In  this  disease  the  oil  has  been  used,  and  by 
some  of  its  vehement  admirers  it  is  said  to  be  equally  beneficial  in  every 
stage.  This  is  not,  however,  the  common  opinion  ;  generally  the  best 
effects  were  found  to  follow  its  use  in  the  early  stage,  where  the  tubercles 
had  not  yet  begun  to  soften,  or  wmere  the  process  had  but  begun.  Here 
the  use  of  the  oil  has  in  very  many  cases  been  followed  pretty  promptly 
by  diminution  of  the  expectoration,  disappearance  of  the  night  sweats, 
and  by  very  marked  increase  in  size,  not  occasioned  by  the  mere  deposi- 
tion of  the  fat,  but  also  by  an  augmentation  of  the  size  of  the  muscles, 
and  a  proportionate  augmentation  of  the  muscular  power.  In  some 
cases  this  improvement  has  been  persistent,  and  the  proportion  of  such 
cases,  where  the. disease  was  in  its  early  stage,  has  been  large.      In 


AT.TEKATIVEH.  581 

phthisis,  wiili  softening,  after  the  formation  of  cavities,  though  the  relief 
for  ;i  time  bas  been  very  decided,  the  night  sweats  ceasing,  the  cough 
becoming  freer,  and  the  expectoration  less  profuse,  in  some  cases,  too, 
flesh  and  strength  being  regained  in  a  most  remarkable  degree,  yel  fchie 
apparent  cure  has  only  amounted  to  an  arrest  of  the  disease  for  a  time. 
In  a  few  months  the  symptoms  return,  and  the  fatal  event,  though  po  t- 
poned,  is  not  prevented.     Such  and  so  greal  are  the  advantages  which 
sonic  of  the  most  eminent  men  among  our  contemporaries  think  they 
have  observed  from  the  use.  of  this  agent  in  that  most  dreadful  of  all 
diseases,    phthisis  pulmonalis.       Is  there,  then,  hope  that  this  terrible 
scourge  is  to  be  at  last  subdued?     Will    it   finally  acknowledge    the 
curative  power  of  this  medicine  ?     We  may  hope,  but  cannot  yet  confi- 
dently believe.     In  the  meantime,  what  is  our  duty  to  our   patients  and 
our  profession?     Try  this  remedy  fairly,  but  carefully.     Let  us  ascertain, 
if  possible,  what  arc  the  circumstances  under  which  it  is  most  likely  to 
do  good  ;  what  are  the  cases  most  likely  to  be  benefited  by  it;  what  are 
the  states  of  system  which  contra-indicate  its  uses ;  what  cases  arc  likely 
to  be  injured  by  it.     These  most  important  questions  are  all  yet  to  be 
settled.     On  no  one  of  them  is  our  present  knowledge  at  all  what  it 
must  be  before  cod  liver  oil  can  be  given  in  any  other  way  than  empiri- 
cally.    It  is  generally  supposed  that  a  state  of  plethora,  of  active  irrita- 
tion, of  general  or  local   inflammation,  or  of  great  nervous  irritability, 
contra-indicate  the  use  of  this  oil.     On  the  other  hand,  it  is  believed 
most   likely  to  succeed  in  those  patients  who  arc  of  sluggish,  apathetic 
habit  of  body,  and  those  most  deeply  and  most  fully  tainted  with  scrofula. 
Modes  of  Administration. — Although  many  modes  of  covering  and 
disguising  the  smell  and  taste  of  this  nauseous  oil  have  been  proposed, 
yet  none  have  availed  anything.     It  can  best  be  taken  either  alone  or 
floating  on  some  aromatic  water.     The  dose  at  first  should  be  small,  say 
a  teaspoonful  thrice  a  day ;  never  to  be  taken  on  an  empty  stomach, 
which  it  is  almost  sure  to  offend,  but  usually  about  one,  or  two  hours 
after  meals.     As  the  stomach   becomes  reconciled  to  it.  the  d<  se  may 
be  increased  to  an  ounce  three  or  four  times  a  day.     By  Mr.  Emery  so 
muchas  a  pint,  and  in  some  cases  a  pint  and  a  half,  was  given  in  cases 
of  lepra  every  day ;  and  the   result,  he   reports,   is  most  encouraging, 
some- very  protracted  cases  being  entirely  cured  by  it.     Such  doses  are 
rarely  necessary,  and  very  rarely  could  patients  be  persuaded  to  swallow 
them.     Sometimes,  when  the  stomach    rejects  the   oil,  if  it  is  omitted 
for  a  few  days  or  weeks,  and  then  given,  it  will  be  retained.      [Little  has 
been   added  to  our  knowledge  of  the  oil  since  the  above  was  written ; 
few  doubt  its  value  in  phthisis. — 2nd  Ed.,  Editor.] 

Sarsa.paiulla. — This  is  the  root  of  a  number  of  species  belonging  to 
the  genus  Smilax.     It  has  generally  been  supposed  to  be  a  product  of 


538  MATERIA    MEDIC  A    AND    THERAPEUTICS. 

the  Smilax  sarsaparilla.  It  is  doubtful,  however,  whether  any  of  the 
sarsaparilla  of  commerce  is  obtained  from  this  source.  The  species 
which  are  now  supposed  to  yield  it,  are  the  Smilax  officinalis,  Smilax 
medica,  and  the  Smilax  papyracea. 

These  grow  in  Mexico,  Guatemala,  and  the  warm  regions  of  South 
America. 

The  smilax  is  perennial,  and  has  a  climbing  or  trailing  stem,  beset 
with  prickles.  The  name  sarsaparilla  is  derived  from  two  Spanish 
words  which  signify  a  small  thorny  vine. 

The  part  used  in  medicine  is  the  roots,  which  consist  of  long  and 
slender  runners,  issuing  from  a  common  head  with  the  stem.  These 
runners  are  the  preferable  part. 

As  found  in  the  market,  they  come  in  bundles  from  about  two  to  four 
feet  long.  They  are  about  the  thickness  of  a  common  quill,  cylindrical, 
and  with  longitudinal  fibres,  and  with  more  or  less  radical  fibres  upon 
them.  They  consist  of  a  thick  cortical  part,  covered  with  an  epidermis 
which  can  easily  be  separated ;  a  thin  inner  layer  of  woody  fibre,  and  a 
central  medulla  or  pith.  The  color  of  the  exterior  varies  from  red  to 
brown  and  grey.  In  the  dry  state  they  have  no  smell ;  on  boiling  the 
smell  becomes  decided.  The  taste  is  mucilaginous,  and  if  chewed  for  a 
little  time,  decidedly  acrid. 

Varieties  of  Sarsajyarilla. — The  principal  varieties  of  this  drug  in  the 
market  are  the  following  : 

1.  The  Lisbon  or  Brazilian  sarsaparilla.  This  is  the  product  of  the 
Brazils,  and  until  of  late  years  found  its  way  to  the  different  parts  of 
the  world  through  the  port  of  Lisbon.  Hence  its  name.  It  is  supposed 
to  be  the  root  of  the  Smilax  papyracea.  This  kind  of  sarsaparilla  is 
of  a  reddish  brown  color,  and  abounds  in  amylaceous  matter,  both  in 
the  bark  and  pith. 

2.  The  Jamaica  Sarsaparilla. — Supposed  to  be  the  product  of  the 
Smilax  officinalis.  It  comes  from  the  bay  of  Honduras,  and  derives  its 
name  from  its  being  brought  to  England  from  Jamaica.  It  is  distin- 
guished by  its  reddish  color,  from  whence  it  is  called  the  red  sarsaparilla. 
It  has  more  radical  fibres  attached  to  it  than  the  preceding.  Contains 
but  little  amylaceous  matter. 

3.  Honduras  Sarsaparilla. — This  comes  from  the  bay  of  Honduras, 
and  is  of  a  dirty  or  greyish  brown  color.  It  has  very  few  fibres 
attached  to  it.  Under  the  epidermis  is  a  thick  amylaceous  layer,  which 
gives  it  a  mealy  appearance  :  hence  called  mealy  sarsaparilla. 

4.  Vera  Cruz  Sarsaparilla. — This  is  supposed  to  be  the  product  of 
the  Smilax  medica.  It  comes  from  Mexico.  This  has  very  few  fibres 
attached — of  a  light  greyish  color.  It  is  more  fibrous  than  the  other 
varieties,  and  contains  no  starch. 

Tests  of  the   Quality. — The  best  test  of  the  quality  of  sarsaparilla  is 


ALTEKATIVKS.  580 

the  taste.    The  more  nauseous  and  acrid  thia  is,  the  better.    In  addition 
to  this,  the  roots  which  have  a  red  color,  and  have  the  greatest  Dumber 

of  root  fibres,  are  considered  the  best.    The  quantity  of  starch  contained 
in  them,  so  far  from  being  a  proof  of  goodness,  is  perhaps  the  rever  e. 

Effects. — Sarsaparilla  does  not  produce  any  direct  and  sensible  eifects 
on  the  system  with  constancy.  Sometimes  il  is  diaphoretic,  again  diu- 
retic; in  very  large  doses  it  irritates  the  stomach,  and  is  said  to  prod 
vertigo.  In  medicinal  doses  it  acts  as  an  alterative  merely,  improves 
the  appetite,  strengthens  the  digestion,  and  invigorates  the  whole  system. 
It  is  given  with  advantage  in  secondary  and  tertiary  venereal  diseases, 
especially  where  the  system  has  been  broken  down  by  the  disease  and 
the  abuse  of  mercury.  In  these  cases  it  is  usually  united  with  stimu- 
lating diaphoretics,  as  mezereon,  sassafras,  &c.  In  chronic  rheumatism 
not  connected  with  syphilis,  it  often  does  good;  so,  too,  in  chronic 
diseases  of  the  skin,  especially  if  they  occur  in  broken-down  constitutions. 

Mode  of  Administration. — Sarsaparilla  is  given  in  infusion  and  decoc- 
tion,  svnip  and  liquid  extract,  and  usually  united  with  gnaiac,  mezereon, 
and  sassafras.  The  officinal  syrup  and  liquid  extract  used  are  the  pre- 
ferable preparations. 

MEZEREON. 

The  tree  which  yields  this  is  the  Daphne  Mezereon,  growing  wild  in 
England  and  the  north  of  Europe.  It  is  a  very  hardy  plant,  growing 
to  the  height  of  four  or  five  feet.  The  bark  of  the  root  is  the  part  used 
in  medicine,  the  ligneous  part  being  nearly  inert.  The  proper  season 
for  digging  up  the  roots  is  the  autumn,  after  the  leaves  have  fallen.  By 
Vauquelin,  a  peculiar  principle  has  been  discovered  in  the  mezereon,  to 
which  he  has  given  the  name  of  Daphnin. 

Mezereon  is  a  -powerfully  stimulating  diaphoretic,  exciting  the  action 
of  the  vascular  system,  and  acting  also  on  the  bowels  and  urinary 
organs.  If  given  too  freely  it  causes  nausea,  vomiting,  and  purging. 
In  its  general  operation,  therefore,  it  is  much  more  active  than  either 
guaiac  or  sarsaparilla.  In  substance  the  dose  of  this  article  is  from  five 
to  ten  grains.  It  is  seldom  used  in  this  way,  however.  The  best  form 
is  that  of  decoction.  This  is  made  by  boiling  §  ij  of  the  mezereon 
with  3  ss  of  liquorice  root  in  lbs  iij  of  water  down  to  a  quart.  Of  this 
tour  or  five  ounces  may  be  given  three  or  four  times  a  day.  Even  thus, 
however,  it  is  at  present  seldom  used  alone. 


SASSAFRAS. 

This  is   the  sassafras  officinale,  a  tree  growing  in  great  abundance 
throughout  the  United  States.     It  grows  frequently  to   the  height  of 

35 


540  MATERIA    MEDICA    AND   THERAPEUTICS. 

thirty  or  forty  feet,  and  even  more.  The  wood,  root,  and  bark,  are  all 
used  in  medicine.  Its  active  properties  are  extracted  both  by  alcohol 
and  water. 

Sassafras  is  a  stimulating  diaphoretic  and  diuretic,  and  is  used  in  the 
same  cases  with  the  preceding  articles.  The  best  form  of  giving  it  is 
the  infusion,  as  decoction  dissipates  the  oil.  In  this  way  it  is  much 
used  as  a  common  domestic  remedy.  The  o^_is  also  a  good  prepara- 
tion in  doses  of  gtt.  ij  to  iv,  rubbed  up  with  sugar  and  water — seldom 
used,  however, 

GUAIAC. 

The  tree  which  yields  the  Gnaiac  is  the  Guaiacum  Officinale,  a  native 
>ef  Jamaica  and  South  America,  rising  generally  to  the  height  of  forty 
feet.  Every  part  of  this  tree  possesses  medicinal  properties,  but  the 
wood  and  a  peculiar  substance,  guaiacum,  afforded  by  it  are  the  only 
parts  used.  This  peculiar  substance  exudes  spontaneously  from  the 
trunk  of  the  tree  in  the  form  of  tears,  or  from  incisions  made  into  the 
trunk.  From  these  it  flows  out  very  copiously,  and  is  concreted  by  the 
sun.  Formerly  this  was  supposed  to  be  a  gum  resin,  but  Mr.  Brande 
declared  it  a  substance  sui  generis,  differing  both  from  gum  and  resin. 
"Its  most  remarkable  property,"  according  to  him,  "is  the  change  of 
color  which  it  undergoes  when  subjected  to  oxygenating  agents."  When 
reduced  to  powder  its  tint  is  pale  grey,  but  by  exposure  to  air  and  light 
it  soon  becomes  of  a  dingy  green.  It  is  now  considered  a  peculiar 
resin. 

It  is  upon  this  substance  that  the  virtues  of  the  guaiac  wood  entirely 
depend.  The  guaiac  wood  comes  in  large,  solid,  and  heavy  pieces,  of  a 
yellow  color,  having  but  little  smell,  and  a  slightly  warm,  subacid  taste. 
When  used  for  medicinal  purposes  it  is  rasped.  The  guaiac  resin  is 
sometimes  found  in  the  form  of  tears,  but  generally  in  large  fused 
masses  "  with  little  smell  and  taste,  brittle  and  semi-transparent,  and  of 
:a  greenish  brown  color." — Brande. 

"The  sensible  effects  of  the  guaiac  are  a  grateful  sense  of  warmth  in 
the  stomach,  dryness  of  the  mouth,  and  thirst,  with  a  copious  flow  of 
sweat,  if  the  body  be  kept  externally  warm,  or  if  the  guaiac  be  united 
with  opium  and  antimonials ;  but  when  the  body  is  freely  exposed, 
instead  of  producing  diaphoresis,  it  augments  considerably  the  secretion 
of  urine."     (Thomson's  Disp.) 

Guaiac  is  a  warm,  stimulating  diaphoretic,  and  has  been  much  used 
as  an  alterativcremedy  in  cases  of  secondary  syphilis,  cutaneous  affec- 
tions, and  the  like.  It  was  originally  employed  by  the  native  Indians 
of  St.  Domingo  as  an  antidote  to  the  lues  venerea.  It  was  from  them 
that  the  Spaniards  became  acquainted  with  its  virtues,  and  in  the  year 


ALTERATIVES.  6  I  I 

1508  it  was  introd need  into  Spain,     tt  speedily  gained  greal  celebrity 
throughout  Europe,  ami  until  the  laal  centurj  continued  to  enjo 
high  a  reputation  as  a  specific  against  the  venereal  that  it  wat  called 
the  lignum  sanctum.     More  accurate  observation  has,  however,  decided 

that  il,  possesses  no  siieli  powers.  It  nevertbelc  exercises  some  con- 
trol over  the  venereal  virus,  and  in  eases  where  the  skin  becomes 
affected  with  ulcers  and  blotches  it  is  a  remedy  of  great  value,  when 
used  in  combination  with  some  of  the  mercurial  preparations.  For  the 
purpose  ofproaucing  the  greatest  sudorific  effect  from  the  guaiac,  the 
body  should  be  kept  warm,  and  the  guaiac  should  be  combined  either 
with  opium  or  antimonials.  If  the  patient  be  freely  exposed,  it  i-  apl 
to  run  off  by  the  kidneys  instead  of  producing  diaphoresis, 

The  gum  guaiac  may  be  given  either  in  substance,  in  doses  of  from 
grs.  x  to  5  ss,  in  pill  or  bolus,  or  what  is  better,  made  into  an  emulsion 
with  water,  by  means  of  gum  arabic  or  the  yolk  of  an  egg.  If  given  in 
larger  doses  it  is  apt  to  produce  a  purgative  effect. 

An  excellent  preparation  of  it  is  the  ammoniated  tincture,  or,  as  it  is 
commonly  called,  the  volatile  tincture  of  guaiac.  This  is  made  by  a 
combination  of  powdered  gum  guaiac  with  the  aromatic  spirit  of 
ammonia.  Of  this,  the  dose  is  one  or  two  teaspoonfuls,  two  or  three 
times  a  day.  Water  decomposes  it,  and  therefore  it  should  be  given 
saturated  with  some  viscid  substance.  This  is  an  admirable  stimulating 
diaphoretic,  and  may  be  used  with  the  greatest  advantage  in  cases  of 
chronic  rheumatism.  It  possesses  over  the  guaiac  alone  the  advantage 
of  a  combination  of  the  ammonia,  which  co-operates  powerfully  as  a 
stimulating  diaphoretic.  *[This  was  the  favorite  remedy  of  Dr.  Dewees 
in  amenorrhcea  and  dysmenorrhea.] 


LOCAL    ALTERATIVES. 

By  these  I  mean  those  agents]  which  possess  the  power  of  altering 
the  condition  of  the  part  to  which  they  are  applied,  in  such  a  way  as 
to  remove  diseased  action.  They  are  the  agents  usually  described  under 
the  names  of  caustics  and  escharotics.  These  terms,  however,  are  objec- 
tionable, as  they  are  calculated  to  convey  erroneous  notions  in  relation 
to  the  effects  and  operation  of  many  of  the  articles  belonging  to  this 
class.  This  will  bo  abundantly  obvious,  when  we  come  to  consider  them 
in  detail. 

NITRATE    OF    SILVER. 

Of  all  the  local  alteratives  this  is  by  far  the  most  valuable,  and  exerts 
a  most  astonishing  influence  in  changing  the  condition  of  the  parts  to 


542  MATERIA   MEDICA   AND  THERAPEUTICS. 

•which  it  is  applied.  When  used  in  the  form  of  the  solid  stick,  its 
effects  differ,  of  course,  according  to  the  mode  of  applying  it.  If  lightly 
rubbed  over  the  skin,  previously  moistened,  or  over  the  surface  of  a 
wound  or  ulcer,  it  first  induces  a  white  film,  which,  when  exposed  to 
the  air  for  a  few  hours,  assumes  a  darker  color,  and  finally  becomes  dark 
grey  or  black.  As  it  undergoes  these  changes  of  color,  it  gradually 
becomes  harder,  and  forms  an  eschar  resembling  black  sticking-plaster. 
In  the  course  of  a  few  days  the  eschar  becomes  corrugated  and  begins 
to  separate  at  its  edges,  and  at  length  peels  off  altogether.  Here  the 
nitrate  of  silver  makes  a  chemical  union  with  the  albumen  of  the  skin 
forming  the  white  film.  This  becomes  gradually  hardened,  and  the 
change  of  color  is  owing  to  the  partial  reduction  of  the  silver. 

Again,  if  the  skin  be  moistened,  and  a  stick  of  nitrate  of  silver  be 
rubbed  lightly  over  it  five  or  six  times,  vesication  takes  place.  In  the 
course  of  four  or  five  days  the  blackened  and  separated  cuticle  falls  off 
and  the  part  heals. 

Again,  if  rubbed  repeatedly  on  a  part  it  acts  as  a  caustic,  destroying 
its  texture.  When  applied  to  mucous  membranes,  it  forms  a  thick 
white  compound  with  the  animal  matter  of  the  mucus.  This  protects 
the  part  underneath  from  the  caustic  effects  of  the  silver,  so  that  the 
effect  is  by  no  means  so  violent  as  it  would  seem.  Simply  stated,  these 
are  the  effects  of  the  local  application  of  this  agent,  and  it  is  upon  these 
that  it  is  used  in  a  great  variety  of  affections  with  the  most  singular 
success. 

The  best  form  in  which  to  use  it  is  that  of  solid  stick. 

1.  In  cases  of  External  Inflammation. — That  nitrate  of  silver,  locally 
applied,  has  the  powTer  of  arresting  inflammation,  was  first  noticed  by 
Dr.  Higginbottom,  who  has  written  an  invaluable  treatise  on  the  effects 
and  uses  of  this  agent.  The  mode  of  applying  it  is  the  following:  the 
part  is  first  to  be  wrashed  with  soap  and  water,  and  then  dried.  The 
inflamed  and  surrounding  part  is  then  to  be  moistened,  and  a  long  stick 
of  nitrate  of  silver  is  to  be  passed  over  the  moistened  surface,  taking 
care  that  not  only  every  part  of  the  inflamed  skin  be  touched,  but  also 
the  surrounding  healthy  skin  to  the  extent  of  an  inch  or  more.  The 
number  of  times  the  stick  is  to  be  passed  over  the  inflamed  surface, 
depends  upon  the  degree  of  inflammation  present.  In  some  cases  sim- 
ply blackening  the  skin  will  be  sufficient,  while  in  others  actual  vesica- 
tion may  be  necessary.  In  very  slight  cases,  accordingly,  passing  the 
stick  once  over  the  part  will  be  sufficient.  In  ordinary  cases,  two  or 
three  times  will  be  necessary,  while,  as  vesication  is  required,  it  must 
be  applied  more  frequently. 


ALTERATIVES.  G  13 

DISEASES    IN    wmcn    THE    NITRATE    OF    SILVER   IS    USED, 

These  .are  various,  and  require  to  be  noticed  in  detail,  as  in  many  of 
them  a  difference  in  the  mode  of  applying  \t  necessary. 

1.  Phlegmon. — In  cases  of  ordinary  phlegmon,  simply  moistening 
the  part  and  rubbing  it  over  with  a  stick  of  nitrate  of  silver,  will  some- 
times have  the  effect  of  arresting  the  progress  of  inflammation,   without 

any  other  application. 

2.  Paronychia. —  Whitlow.— -In   cases  of   this  kind,  frequently  the 

best  application  to  the  part  is  nitrate  of  silver,  first  moistening  the  sur- 
face and  then  rubbing  the  stick  once  or  twice  over  it.  In  case  suppura- 
tion should  have  actually  taken  place,  the  best  plan  is  to  open  the 
abscess,  then  applying  the  nitrate  freely  within  the  cavity,  and  after- 
wards cover  the  whole  with  a  cold  bread  poultice.  In  most  cases  this 
will  entirely  relieve  the  pain  and  irritation,  after  the  immediate  smarting 
of  the  application  has  subsided.  Should  the  inflammation  be  increased 
in  a  day  or  two,  as  it  sometimes  is,  the  application  may  be  renewed. 

3.  Erysipelas. — There  is  perhaps  no  disease  in  which  the  effects  of 
the  local  application  of  the  nitrate  of  silver  are  so  striking  as  in  this. 
For  the  first  suggestion  of  it,  I  believe  we  are  indebted  to  Mr.  Higgin- 
bottom,  who  has  detailed  some  very  interesting  cases,  in  which  it  was 
used  with  success.  As  yon  all  know,  this  disease  is  not  always  purely 
local.  It  is  connected  with  constitutional  derangement  requiring 
general  treatment.  Bloodletting,  purging,  antimonials,  etc.,  are  of 
course  to  be  first  resorted  to.  If  these  should  fail  to  arrest  the  disease, 
the  best  mode  is  first  to  moisten  the  whole  inflamed  surface  and  then 
pass  a  long  stick  of  the  nitrate  over  every  part  of  it,  extending  the 
application  a  little  distance  beyond  on  the  surrounding  healthy  skin. 
Strange  as  it  may  be,  the  progress  of  the  inflammation  appears  to  be 
immediately  arrested,  and  in  the  course  of  two  or  three  days  frequently 
every  appearance  of  inflammation  will  have  disappeared.  In  about  five 
or  six  days,  the  eschar  separates. 

4.  Inflammation  of  Absorbents. — In  eases  of  this  kind,  which 
frequently  are  so  painful  and  dangerous,  there  is  nothing  so  prompt  and 
efficient  as  the  local  application  of  this  remedy.  Generally  speaking, 
inflammation  of  this  sort  arises  from  some  local  injury  extending  in  the 
extremities  to  the  axilla  and  groin.  In  such  cases  the  best  plau  is  to 
rub  the  nitrate  not  merely  over  the  part  first  affected,  but  over  the  whole 
course  of  inflamed  absorbents. 

5.  Punctured  Wounds. — In  the  slighter  of  these  the  effects  of  the 


544  MATERIA   MEDICA    AND   THERAPEUTICS. 

application  of  the  nitrate  are  really  astonishing,  in  arresting  the  inflam- 
mation and  entirely  curing  the  injury.  In  these  cases  all  that  is  neces- 
sary to  be  done  is  to  moisten  the  part  first  and  then  pass  a  stick  of  the 
nitrate  to  the  wound,  and  to  pass  it  once  or  twice  over  the  whole 
inflamed  part,  extending  it  about  an  inch  beyond  on  the  healthy  skin. 
Generally.nothing  else  is  necessary.  Where  the  case  has  been  neglect- 
ed and  matter  has  already  formed,  the  matter  is  to  be  evacuated  and 
the  nitrate  applied  within  the  cavity.  A  cold  poultice  is  then  to  be 
applied.  In  two  or  three  days  the  application  may  be  renewed,  in  case 
there  should  still  be  any  swelling  or  inflammation  left.  In  this  way 
ordinary  wounds  from  instruments,  etc.,  the  bites  of  animals,  inflamed 
leech  bitesr  and  vjounds  received  in  dissection^  may  be  treated. 

Where  the  punctured  wound  has  been  extensive,  a  good  way  of 
treating  it  is  to  apply  the  nitrate  first  and  then  bring  the  edges  together 
by  adhesive  plaster.  In  this  way  the  excessive  inflammation  and  sup- 
puration which  frequently  attend  these  cases  are  kept  down,  and  the 
part  heals  nearly  as  by  the  first  intention. 

6.  Bruised  Wounds. — In  these  cases,  whether  of  simple  bruised 
wounds,  or  of  the  more  severe  kind,  accompanied  with  inflammation  or 
followed  by  sloughs,  the  application  of  the  nitrate  is  attended  with  the 
same  salutary  effects  as  in  punctured  wounds. 

7.  Ulcers. — In  the  treatment  of  these  intractable  cases,  the  nitrate 
of  silver  pi-oves  an  invaluable  remedy.  In  small  ulcers,  simply  applying 
it  to  the  surface  and  a  little  on  the  surrounding  skin,  and  after  this 
covering;  the  whole  with  gold-beater's  skin,  is  all  that  is  necessary. 

In  large  ulcers  with  inflammation,  or  in  old  ulcers,  the  treatment  is 
the  following:  first  apply  a  bread  and  milk  poultice  over  the  ulcer, 
and  let  the  patient  keep  his  bed  for  18  or  24  hours.  All  the  inflamed 
parts  are  then  to  be  well  washed  with  soap  and,  water  and  wiped  dry, 
They  are  then  to  be  moistened  with  water,  and  a  long  stick  of  the 
nitrate  is  to  be  passed  all  over  the  inflamed  and  ulcerated  surfaces  twice,, 
and  rather  more  freely  on  the  ulcer  itself.  It  must  also  be  carried 
somewhat  on  the  surrounding  skin.  Lint  must  then  be  applied  to  the 
ulcer,  and  the  whole  inflamed  and  ulcerated  parts  covered  with  the 
neutral  ointment,*  spread  on  linen.  A  compress  of  linen  five  or  sis 
folds  thick  is  then  to  be  put  over  the  ulcer,  and  a  common  roller  to  be 

*   §     Empl.  Plumbi  lbs.  if. 
01.  Oliv.  lbs.  ij, 
Cretffi  ppt.   3  xvij. 

Aeetum  Distillat.  lbs  ij.  M. 

The  acid  and  chalk  to  be  well  mixed  in  a  mortar,  the  lead1,  plaster,  and  oiT, 
previously  slowly  melted  together,  are  next  added^  and  the  whole  stirred  till 
eool. 


A  LTERATIVES.  545 

loosely  applied  round  the  whole.  On  the  fourth  day  the  leg  is  to  I"; 
examined,  when  it  will  be  found  that  the  inflammation  i  nearly  if  not 
entirely  gone,  and  the  ulcer  is  in  a  healing  state.  The  nitrate  must 
then  be  applied  on  the  whole  of  the  ulcer,  and  once  lightly  over  the 
skin  immediately  surrounding  it,  one  or  two  inches  in  breadth.  The 
lint,  ointment,  etc.,  to  be  applied  as  before.  Every  third  or  fourth  day 
this  is  to  be  repeated  until  the  ulcer  is  healed.  After  the  first  or  second 
application  the  patient  may  walk  about. 

Caustic  Potash. — Tin's  is  the  hydrate  of  Potash.  Also  called  the 
potassa  fusa,  or  fused  potash. 

It  is  prepared  by  evaporating  a  solution  of  potassa  in  a  clean  iron 
vessel  over  the  fire  until  ebullition  ceases  and  the  potassa  melts.  Jt  is 
then  poured  into  proper  moulds.  The  best  kind  of  moulds  are  of  iron 
and  of  a  cylindrical  shape. 

In  this  process  all  the  uncombined  water  is  driven  off  by  the  action 
of  heat,  and  the  potassa  remains  in  the  state  of  hydrate.  It  contains 
one  equivalent  of  potassa  48,  and  one  of  water  9  =  57;  or  in  100  parts, 
84  potassa  and  16  water. 

When  perfectly  pure,  the  hydrate  of  potassa  is  of  a  white  color.  The 
officinal  preparation,  however,  owing  to  impurities,  is  greyish  or  bluish. 
It  is  soluble  in  water  and  alcohol,  but  usually  not  entirely  so,  in  conse- 
quence of  the  impurities;  when  pure,  it  is  entirely  soluble.  It  has  a 
very  strong  affinity  for  water  and  carbonic  acid,  which  it  attracts  rapidly 
from  the  atmosphere,  and,  in  consequence  of  this,  it  deliquesces.  Hence 
the  necessity  of  keeping  it  in  tightly-stopped  bottles. 

Purity. — The  officinal  hydrate  contains  various  impurities,  such  as 
peroxide  of  iron,  carbonate  of  potash,  silica,  alumina,  &c,  which  exist  in 
the  carbonate  of  potash,  from  which  the  solution  of  potassa  is  prepared. 
These,  however,  do  not  interfere  with  the  medicinal  virtues  of  the  article. 
They  may  be  separated  by  digesting  it  in  alcohol,  which  takes  up  onlv 
thc  pure  alkali ;  by  evaporating  this  alcoholic  solution  to  dryness  and 
fusing  the  mass  thus  obtained. 

Effects. — This  is  the  strongest  caustic  that  we  possess,  and  hence  was 
known  by  the  name  of  causticuifl  fnmmiirtp  nrerrimMm  When  applied 
in  the  solid  form  to  any  part,  it  quickly  destroys  its  vitality,  and  extends 
its  action  to  the  parts  beneath,  forming  a  slough,  which  is  afterwards 
thrown  off,  leaving  behind  it  au  open  ulcer. 

The  principal  use  of  this  article  is  to  form  issues.  In  rising  it  for  this 
purpose,  however,  it  is  necessary  to  be  cautious.  As  it  is  very  deli- 
quescent, it  is  apt  to  spread,  and  thus  extend  its  effects  too  far.  A  piece 
of  adhesive  plaster  should,  therefore,  be  first  applied  to  the  part,  with  a 
hole  cut  in  it  of  a  suitable  size  where  you  intend  making  the  issue.  To 
this  open  part  the  caustic,  moistened  at  one  end,  should  be  rubbed  until 


546  MATERIA    MEDICA   AND   THERAPEUTICS. 

the  part  becomes  discolored  or  dies.  It  is  then  to  be  washed  and  a 
poultice  applied.  When  the  eschar  separates,  the  issue  is  to  be  con- 
tinued by  keeping  a  pea  in  it.  It  is  also  used  to  destroy  warts  and 
fungous  growths. 

Potassa  cum  Calce. — This  is  also  called  the  Causticum  commune 
mitius,  or  the  Causticum  commune  cum  calce.  This  is  prepared  by  eva- 
porating solution  of  potassa  to  one  third,  and  then  adding  as  much  newly 
slacked  lime  as  will  bring  it  to  the  consistence  of  a  solid  paste.  This  is 
then  to  be  preserved  in  well-stopped  bottles. 

This  consists  of  the  mixed  hydrates  of  potassa  and  lime.  It  possesses 
the  advantage  of  being  less  deliquescent  than  the  caustic  potassa.  It  is, 
therefore,  more  manageable.  It  is  milder  and  slower.  Its  general 
action,  however,  is  the  same. 

When  applied,  it  is  made  into  a  paste  with  rectified  spirits. 

Arsenious  Acid. — Although  commonly  ranked  among  them,  this 
article  produces  effects  very  different  from  the  simple  caustics. 

When  applied  in  small  quantities  to  the  sound  skin,  it  does  not  pro- 
duce any  effect.  When  applied  in  considerable  quantities,  however,  it 
has  been  known  to  cause  local  irritation,  followed  by  a  pustular  erup- 
tion, and  in  some  cases  the  constitutional  effects  of  it  have  been  deve- 
loped. Several  cases  are  recorded  in  which  this  article  has  been  applied 
by  mistake  to  the  head  for  hair  powder,  and  in  all  these  constitutional 
effects  have  followed.  One  proved  fatal.  When  rubbed  on  the  sound 
skin  in  the  shape  of  ointment,  it  produces  generally  a  pustular  eruption  ; 
sometimes  an  eschar,  and  not  unfrequently  the  system  becomes  consti- 
tutionally affected. — (Christison.)  When  applied  to  surfaces  deprived 
of  the  cuticle,  the  effects  are  much  more  energetic.  Great  local  irrita- 
tion is  caused,  while  the  poison  is  absorbed  frequently  with  great  rapidity, 
and  all  the  constitutional  effects  of  it  developed.  Applied  to  eruptions, 
ulcers,  and  wounds,  it  has  frequently  proved  fatal.  In  its  application  to 
ulcerated  surfaces,  there  is  a  circumstance  of  great  interest  which  has 
frequently  been  noticed;  and  that  is,  that  while  some  persons  are 
affected  by  a  single  application,  "  others  have  had  it  applied  for  a  length 
of  time  without  experiencing  any  other  consequence  than  the  formation 
of  an  eschar  at  the  part." — (Christison.)  For  this  two  reasons  have  been 
assigned.  The  first  is,  the  difference  in  the  quantity  applied.  When  a 
large  quantity  is  applied,  the  part  is  speedily  disorganized,  and  absorp- 
tion is  thus  prevented.  On  the  other  hand,  where  the  quantity  is  small, 
the  local  effect  is  trifling,  and  absorption  readily  takes  place.  A  second 
is  the  condition  of  the  sore  to  which  it  is  applied.  If  there  be  any 
bleeding  vessels,  absorption  takes  place  very  readily,  and  the  system  is 
easily  affected.  On  the  other TTand,  if  there  be  no  bleeding  vessels,  this 
effect  is  much  less  likely  to  happen. — (Christison,  p.  223.) 


ALTERATIVES.  54  7 

The  practical  conclusions  to  be  drawn  from  the  foregoing  are  import- 
ant, and  they  are  the  following  : 

1.  The  arsenic  should  always  be  applied  strong,  so  as  to  di  organize 
tho  part  as  speedily  as  possible. 

2.  Before  applying  it  the  part  should  never  be  prepared  bj  cutting 
and  paring,  so  as  to  cause  bleecnng. 

By  attending'  to  these  precautions,  the  absorption  of  the  article  may 
probably  in  many  cases  be  prevented,  and  many  evil  effects  obviated. 

When  properly  applied  to  an  ulcerated  surface,  the  part  is  destroyed 
and  sloughs  off;  a  new  action  is  thus  created,  and  a  healthier  secretion 
promoted. 

The  disease  in  which  arsenic  has  been  chiefly  used  is  cancer,  and  this 
is  the  article  generally  resorted  to  by  empirics.  In  many  cases  it  no 
doubt  serves  a  good  purpose  in  improving  the  character  of  the  sore, 
and  perhaps  retarding  the  progress  of  the  disease.  Experience,  how- 
ever, has  abundantly  shown  that  it  cannot  eradicate  the  disease,  while 
from  the  absorption  the  most  dangerous  and  even  fatal  consequences 
have  resulted.  By  regular  practitioners  it  is,  therefore,  in  a  great  mea- 
sure abandoned. 

It  is  also  used  in  Lupus  with  advantage,  and  more  recently  in  Ony- 
chia maligna  with  great  success.     (Pereira.) 

Mode  of  Application. — The  best  form  is  the  ointment.  This  is  made 
by  rubbing  up  one  scruple  of  finely-powdered  arsenious  acid  with  one 
ounce  of  simple  cerate.  This  must  be  applied  with  caution  and  the 
effects  watched. 

The  preparation  used  for  onychia  maligna  is  arsenious  acid,  grs.  ij  ; 
spermaceti  oint.   3  i. 

[Hydrargyri  Supernitras  (the  Acid  Nitrate  of  Mercury). — A  so- 
lution of  the  nitrate  of  mercury  in  nitric  acid,  under  the  name  of  the 
acid  nitrate  of  mercury,  is  much  used  as  a  caustic  in  Paris,  and  has 
been  adopted  by  some  practitioners  in  England  and  the  United  States. 
It  is  chiefly  used  in  cases  of  severe  and  extensive  ulceration  of  the  os 
uteri.  It  should  be  applied  by  a  brush,  and  very  great  care  taken  that 
it  does  not  fall  upon  the  vagina,  or  touch  the  healthy  tissue  of  the 
uterus. — Ed.] 


CHEMICAL    ALTERATIVES. 

The  two  most  important  classes  of  chemical  alteratives  are : 
1st.  Antacids,  or  those  remedies  which  obviate  acidity  of  the  stomach 
by  combining  with  and  neutralizing  the  acid. 


548  MATEEIA   MEDIC  A    AND   THEEAPETTTICS. 

2d.  Lithics,  or  tliose  remedies  which  are  given  to  counteract  the  dis- 
position to  form  urinary  calculi. 

I  shall  speak  of'each  of  these  in  their  order. 

Antacids. — The  presence  of  acid  in  the  stomach  is  essential  to  the 
performance  of  its  functions.  It  is  of  course  only  when  this  is  in  excess 
that  it  becomes  a  proper  subject  for  medicinal  treatment. 

It  is  not  yet  well  settled  what  acids  are  present  in  the  gastric  juice, 
nor  in  what  state  they  exist  in  that  fluid,  some  supposing  that  muriatic, 
acetic,  and  lactic  acids  exist  in  a  free  state.  Blondelot,  on  the  other 
hand,  denies  altogether  the  existence  of  free  acid  in  the  stomach,  insist- 
ing that  the  acidity  of  the  gastric  juice  depends  on  the  presence  of  the 
acid  biphosphate  of  lime.  The  probabilities  are  that  free  acids  exist, 
and  that  the  same  acid  does  not  exist  in  the  gastric  juice  of  different 
animals,  nor  in  that  of  the  same  animals  at  all  times;  for  though  the 
acidity  is  essential,  it  seems  that  this  quality  in  the  absence  of  one  acid 
can  be  communicated  by  another.  The  acids  which  are  thought  to 
exist  in  the  normal  state  in  gastric  juice  are,  as  before  stated,  the  muri- 
atic, lactic,  and  acetic,  and  it  is  probable  that  when  acid  is  in  excess,  it 
is  by  the  increase  of  one  or  other  of  these.  They  are  in  all  cases  deve- 
loped from  the  food  ;  muriatic  from  animal  food,  lactic  and  acetic  from 
vegetables.  It  is  then  to  saturate  the  excess  of  these  acids,  and  not  to 
neutralize  the  gastric  juice,  or  remove  acid  from  the  stomach,  still  less 
to  render  it  alkaline,  that  antacids  are  given  ;  and  if  you  remember, 

1st.  That  the  excess  of  acid  is  generated  from  changes- in  the  food. 

2d.  That  these  changes  depend  on  imperfect  digestion. 

3d.  That  digestion  cannot  but  be  imperfect,  when  there  is  in  the 
stomach  sufficient  alkali  to  neutralize  the  gastric  juice,  you  will  readily 
understand  the  reason  for  a  fact,  long  familiar  to  practical  men,  viz.  that 
it  is  very  possible  to  remove  an  effect  of  disease,  and  yet  not  remove, 
but  actually  aggravate  the  disease  itself.  Here  the  essence  of  the  dis- 
ease is  the  disposition  in  the  stomach  to  produce  an  undue  quantity  of 
acid  from  the  food,  and  in  neutralizing  this  excess  of  acid,  and  thus 
removing  an  effect,  we  may  aggravate  the  disposition  in  the  stomach, 
which  is  the  disease. 

This  injurious  effect  of  antacids  may  be,  in  part  and  for  a  time,  pre- 
vented by  the  use  of  vegetable  bitters,  and  alkalies  ought  not  to  be  long 
used,  without  giving  the  tonics;  but  even  with  these  the  evil  effects 
cannot  be  prevented  entirely,  if  the  remedy  is  used  freely,  and  for  a 
long  time.  Always,  therefore,  discourage  the  long-continued  use  of 
alkalies,  especially  the  too  common  practice  of  taking  them  immediately 
after  each  meal. 

Magnesia. — Under  the  head  of  cathartics  this  earth  has  already  been 


ai.tki.wi  ivks.  549 

noticed,  and  it  was  then  mentioned  thai  it  was  nsed  in  three  forms,  viz: 
the  sulphate,  the  carbonate,  and  the  pure  magnesia,  or  magnet  ia  usta,  [n 
either  of  these  two  latter  forms,  magnesia  may  l>e  nsed  as  an  antacid. 
The  difference  between  them  is,  thai  when  the  carbonate  is  used,  large 
quantities  of  carbonic  acid  gas  are  extricated  in  the  stomach.  In 
instances  the  extrication  of  this  gas  is  objectionable,  from  the  distension 
of  the  stomach  which  it  occasions.  Generally,  however,  no  harm  can 
arise  from  it,  and  the  stimulus  of  the  gas  is,  in  many  cases,  rather  grate- 
ful than  otherwise  to  the  stomach,  and  whenever  nausea  and  vomiting 
are  present,  may  be  exceedingly  beneficial.  As  an  antacid,  magnesia  is 
one  of  the  most  efficacious  articles  that  we  possess.  Nexl  to  ammonia, 
it  has  the  greatest  power  of  neutralizing  acids  of  any  of  the  alkalies  or 
alkaline  earths.  It  is  peculiar  to  this  article  that,  when  it  combi 
with  an  acid  in  the  stomach,  it  proves  purgative.  In  this  respect  it 
differs  from  the  other  antacids. 

Mode  of  Administration. — It  may  be  given  in  doses  from  3  ssto__3^ 
in  milk  and  water.  To  correct  the  flatulence  which  it  occasions,  a  small 
quantity  of  some  aromatic  may  be  added.  In  dyspeptic  states  of  the 
stomach,  a  little  of  the  compound  spirit  of  ammonia  is  frequently  bene- 
ficial. 

Of  the  pure  magnesia  the  dose  may  be  about  one  third  less  than  that 
of  the  carbonate. 

Greta — Chalk. — This  is  a  friable  carbonate  of  lime,  and  is  found  in 
great  abundance  in  different  parts  of  Europe.  In  the  South  of  England, 
particularly,  it  exists  in  great  quantities.  Marble  is  the  hard  carbonate 
of  lime.  With  the  acids  chalk  effervesces,  the  carbonic  acid  gas  being 
extricated.  "With  muriatic  acid  it  effervesces  violently,  and  dissolves 
almost  entirely,  leaving  a  colorless  solution. 

When  by  levigation  and  washing  the  chalk  is  separated  from  any  im- 
purities that  may  be  associated  with  it,  it  is  called  Creta  preparata  or  Pre- 
pared chalk.  This  is  the  form  in  which  it  is  used  in  medicine.  As  an 
antacid,  it  has  been  and  is  still  used.  It  differs  from  magnesia  in  not 
producing  any  purgative  effect.  On  the  contrary,  it  proves  absorbent 
and  astringent.  It  is,  therefore,  used  with  much  advantage  in  cases  in 
which  magnesia  would  be  improper.  The  dose  of  it  is  from  3j  to  3  j- 
The  common  form  in  which  it  is  prescribed,  is  that  of  the  chalk  mix- 
ture, i  i    eLuh,  z+^Y*  t*^  '  ^^"^ 


Lime  "Water. — This  is  a  limpid,  colorless  fluid,  without  smell,  and 
having  a  strong,  styptic,  acrid  taste.  It  changes  vegetables  blues  to 
green.  It  unites  with  oil,  forming  an  imperfect  soap.  When  exposed 
to  the  air,  a  pellicle  forms  on  its  surface,  which,  when  it  becomes  of  a 
certain  thickness,  cracks  and  sinks  to  the  bottom.     It  is  then  succeeded 


550  MATERIA    MEDIC  A   AND   THERAPEUTICS. 

by  others  of  a  similar  character.  The  explanation  of  this  is  the  follow- 
ing: The  lime  of  the  lime  water  attracts  carbonic  acid  from  the  air, 
and  forms  a  carbonate  on  the  surface,  which  is  the  pellicle  just  mentioned. 
By  successive  formations  the  whole  of  the  lime  is  thus  abstracted.  It 
is  for  this  reason  that  it  is  necessary  to  keep  lime-water  in  closely  stopped 
bottles. 

As  an  antacid,  lime-water  is  much  used,  and  is  an  article  of  great 
value.  Besides  the  power  which  it  possesses  of  neutralizing  acid,  it  has 
the  still  further  property  of  dissolving  the  sordid  mucus  with  which  the 
stomach  and  bowels  are  generally  loaded  in  dyspeptic  and  otherwise 
debilitated  states  of  these  organs.  In  the  same  way  it  proves  serviceable 
in  cases  of  worms  by  dissolving  the  slimy  mucus  in  which  these  animals 
are  imbedded. 

The  dose  is  from  3  j  to  3  ij,  or  3  iij.  Where  the  stomach  is  irritable, 
a  good  form  of  giving  it  is,  mixed  with  an  equal  quantity  of  milk. 

Potash. — Carbonic  acid  combines  with  potash  in  two  proportions, 
constituting  a  carbonate  and  a  bicarbonate. 

(a.)  Carbonate  of  Potassa. — (Salt  of  Tartar.) — As  found  in  the  shops, 
this  salt  is  in  white  grains,  with  an  alkaline  and  nauseous  taste;  it 
changes  vegetable  blues  to  green,  and  unites  with  oils  and  forms  soap. 
On  exposure  to  the  air  it  is  very  deliquescent,  and  forms  a  fluid  of  the 
consistence  of  oil.  This  salt  contains  one  proportion  of  carbonic  acid 
with  one  of  potassa.     It  is  soluble  in  water,  but  insoluble  in  alcohol. 

(b.)  Bicarbonate  of  Potassa. — This  salt  is  prepared  by  passing_a_stream 
of  carbonic  acid  gas  through  a  solution  of  the  carbonate  of  potassa. 
When  it  ceases  to  absorb  carbonic  acid,  it  is  to  be  filtered  and  eva- 
porated slowly  until  regular  crystals  form.  This  salt  contains  twice  as 
much  carbonic  acid  as  the  preceding  carbonate,  or  two  proportions  of 
acid  to  one  of  potassa. 

This  is  white,  crystalline,  without  smell,  and  having  a  weak  alkaline 
taste,  without  any  acrimony.  On  exposure  to  the  atmosphere  it  does 
not  undergo  any  change.     It  is  soluble  in  about  four  parts  of  cold  water. 

Effects  on  the  System. — In  their  effects,  these  salts  do  not  differ  much. 
They  are  both  powerfully  antacid,  and  extend  their  operation  from  the 
stomach  to  the  urinary  organs,  increasing  the  secretion  of  urine,  and 
altering  the  chemical  constitution  of  that  fluid.  Although  possessing 
the  same  general  properties,  however,  the  bicarbonate  has  great  advan- 
tao-es  over  the  carbonate.  It  is  less  nauseous  and  acrid  in  its  taste,  and 
agrees  better  with  the  stomach. 

The  dose  is  from  grs.  x  to  grs.  xxx,  in  some  mucilaginous  vehicle. 

(c.)  Liquor  Potass^e. — (Solution  of  Potassa). — This  is  another  form 
in  which  potassa  is  used.     It  is  prepared  by  making  separate  solutions 


ALTERATIVES.  651 

of  carbonate  of  potassa  and  caustic  lime  in  boiling  water,  and  then  mix- 
ing these  together,  and  when  cold,  straining,  <fec.  Here  the  lime  attract* 
the  carbonic  acid  from  tlie  potassa,  and  leaves  the  alkaline  base  in  a 
state  of  purity.  To  prevent  its  absorbing  carbonic  acid  from  the  atmo- 
sphere, it  should  be  kept  in  glass  bottles,  witli  ground  stoppers. 

The  liquor  potassa?,  when  pure,  is  a  limpid,  colorless  fluid  ;  its  hi  t< 
is  acrid  and  caustic.  It  changes  vegetable  blues  to  green,  and  docs  not 
effervesce  with  acids.  It  is  a  powerful  antacid,  and  extends  its  opera- 
tions to  the  urinary  organs.  It  docs  not,  however,  appear  to  possess 
any  advantage  over  the  carbonate,  and  is  more  apt  to  disagree  with  the 
stomach.  The  dose  is  from  gtt.  x  to  git.  xxx,  taken  in  broth,  milk, 
common  table  beer,  or  some  bitter  infusion. 

Soda. — Like  Potassa,  Soda  combines  with  carbonic  acid  in  two  pro- 
portions. 

(a.)  Carbonate  of  Soda. — This  salt  is  in  large  white  crystals.  It 
is  without  smell.  On  exposure  to  the  atmosphere  it  effloresces  and 
crumbles  into  a  white,  opaque  powder.  It  consists  of  one  proportion  of 
carbonic  acid  and  one  of  soda. 

(p.)  Bicarbonate  of  Soda. — This  salt  is  prepared  in  the  same  way 
as  the  bicarbonate  of  potassa,  and  contains  two  proportions  of  the  acid 
to  one  of  the  soda.  It  forms  in  crystals — less  soluble  in  water  than  the 
carbonate.  When  dried,  these  crystals  effloresce  and  lose  part  of  their 
carbonic  acid,  so  that  what  is  usually  found  in  the  shops  under  the 
name  of  the  carbonate  is  intermediate  between  the  carbonate  and  the 
bicarbonate,  forming  a  sesquicarbonate  of  soda.  [A  mixture  of  the  two 
carbonates. — Graham.] 

Effects  on  the  System. — The  carbonates  of  soda  are  analogous  in  their 
operation,  *the  only  difference  being  that  the  bicarbonate  is  less  alkaline 
and  unpleasant  in  its  taste,  and  generally  sits  better  on  the  stomach. 
The  carbonates  of  soda  are  generally  more  used  than  those  of  potassa. 
They  are  more  pleasant,  sit  easier  on  the  stomach,  especially  if  their 
use  is  to  be  continued,  and  at  the  same  time  appear  to  be  more  effica- 
cious. The  dose  is  from  grs.  x  to  grs.  xxx  or  xl,  dissolved  in  water  or 
almond  mixture.  A  very  pleasant  mode  of  giving  soda  is  in  soda  water. 
The  taste  of  the  soda  is  here  almost  entirely  covered  by  the  carbonic 
acid. 

Carbonate  of  Ammonia — (  Volatile  alkali). — This  salt  does  not 
exist  in  nature,  but  forms  spontaneously  in  the  decomposition  of  animal 
matter.     It  is  also  prepared  artificially  for  medicinal  purposes. 

It  has  a  penetrating,  pungent  odor,  and  an  acrid  taste.     It  is  usually 


552  MATERIA.   MEDICA   AND   THERAPEUTICS. 

in  white  serai-transparent  masses  of  a  crystalline  appearance.  On 
exposure  to  air  it  effloresces.  It  should  be  kept  in  well  stopped  bottles, 
for  when  exposed  to  the  air,  it  gradually  loses  ammonia,  becomes  opaque, 
pulverulent,  and  less  pungent,  and  ultimately  passes  into  a  hydrated 
bicarbonate  of  ammonia.  It  possesses  alkaline  properties,  and  is  soluble 
in  about  three  parts  of  cold  Avater. 

Effects. — As  an  antacid  this  salt  possesses  very  active  properties. 
Besides  neutralizing  acid,  which  it  does  very  effectually,  it  has  the 
advantage  of  being  powerfully  stimulant,  and  is  on  this  account  particu- 
larly useful  in  debilitated  states  of  the  stomach,  accompanied  with 
acidity~ancT11atulence. 

Form. — Pill  or  bolus,  in  doses  of  from  ij  grains  to  x  grs. 


CHEMICAL    ALTERATIVES. 

Lithics. — Under  this  head  I  shall  treat  of  those  remedies  which  are 
calculated  to  correct  some  of  the  most. common  morbid  states  of  the 
urine  which  are  manifested  by  deposits.  To  make  this  subject  intelligi- 
ble, it  is  necessary  to  say  a  few  words  on  the  urine  in  health. 

Healthy  urine,  when  recently  voided  and  yet  warm,  is  an  amber- 
colored  fluid,  having  a  peculiar  aromatic  smell,  and  a  saltish,  disagreea- 
ble taste.  On  cooling,  the  smell  changes  to  that  usually  called  urinous, 
which  it  retains  till  it  begins  to  decompose,  when  it  has  a  foetid, 
ammoniacal  odor.  Its  specific_gmyity  may  vary  from  1005  to  1030, 
but  its  usual  range  is  from  1015  to  1020.  The  quantity  voided  is  sub- 
ject to  remarkable  variations,  even  in  perfect  health,  sometimes  falling 
below  20  ounces,  and  at  others  exceeding  50.  The  average  is  about 
32,  or  two  pints.  The  quantity  of  solid  matter  in  the  urine  is,  like  all 
its  other  qualities,  subject  to  vary  from  a  great  number  of  causes.  Its 
average  is  about  64  grains  in  24  hours.  This  supposes  that '  32  ounces 
of  urine  of  the  specific  gravity  of  1020  are  passed,  each  ounce  of  the 
fluid  containing  20  grains. 

Not  only  does  the  urine  of  different  persons,  and  of  the  same  persons 
at  different  times,  vary,  but  there  is  a  pretty  regular  change  which  the 
fluid,  in  all  healthy  persons,  undergoes  at  different  periods  of  the  day. 
That  passed  after  rising  from  bed  in  the  morning,  and  of  course  after 
several  hours  of  abstinence  from  food  or  drink,  is  commonly  called  urina 
sanguinis.  It  furnishes  a  fair  specimen  of  the  average  density  ,  of 
the  whole  urine.  That  passed  soon  after  the  digestion  of  a-  full  meal, 
called  urina  chyli,  is  of  high  specific  gravity,  while  that  which  flows 
after  the  taking  of  large  draughts  of  water,  called  urina  potus,  has  a 
low  specific  gravity,  is  of  pale  color,  and  is  sometimes  nearly  pure  water. 
The  urine  is  a  very  complex  fluid,  and  chemists  are  scarcely  yet  agreed 


ALTERATIVES.  558 

as  to  its  composition.      fnto  the  nicetiet   of  this  analysis  I   need   not 
enter:  ray  purpose  will  be  served  by  calling  your  attention  to  a  very 
general  view  of  its  composition. 
It  contains  in  one  thousand  parts  : 

1.  Water, from  930     to     960 

2.  Urea,        24      to        14 

8.    Uric  acid L'3  to  0-90 

4.  Alkaline  and  earthy  salts,    .      L5     to        5 

5.  Other  solid  matters     .     .     .      80     to       20 

Of  these  constituents  of  urine  the  most  important  are  urea,  uric  acid, 
and  the  alkaline  and  earthy  salts,  these  latter  being  chiefly  phosphates 
of  soda,  lime,  and  magnesia,  sulphates  of  potash  and  soda,  muriate  of 
ammonia,  and  chloiide  of  sodium  or  common  salt.  The  proportion  of 
these  several  ingredients  may  vary  very  much  without  exceeding  the 
limit  of  health.  When,  however,  the  quantity  of  any  one  is  very  much 
either  increased  or  diminished  it  constitutes,  not  always  a  disease — this 
is  a  matter  of  great  importance  and  to  be  kept  always  in  view — hut  a 
symptom  of  some  diseased  state  of  the  system,  very  generally  conne  sted, 
more  or  less  intimately,  with  faulty  digestion.  But  the  urine  becomes 
morbid,  not  only  by  the  faulty  proportions  of  its  normal  ingredients,  but 
it  sometimes  contains  matters  which  are  not  properly  constituents  of  the 
fluid;  of  these  the  most  important  are  albumen,  sugar,  pus,  blood,  and 
bile.  None  of  these  are  ingredients  in  healthy  urine,  yet  even  their 
presence  is  not  always  to  be  taken  as  an  evidence  of  disease  ;  it  may7  be 
that  they  exist  there  in  consequence  of  the  vigorous  efforts  the  system 
is  making  to  eliminate  noxious  matters. 

From  what  is  above  stated  it  is  obvious  that  morbid  states  of  the  urine 
may  be  divided  into  two  general  classes  : 

I.  Those  in  which  some  normal  constituent  of  the  urine  is  in  excess. 

II.  Those  in  which  the  urine  contains  some  principle  which  is  not 
found  in  it  in  the  state  of  health. 

1.  Morbid  states  of  the  urine  in  which  some  normal  ingredient  is 
in  excess. — The  normal  ingredients  of  the  urine  which  are  most  fre- 
quently found  in  excess  are  : 

1.  Urea;  2.  Uric  acid  and  the  urates;  3.  The  phosphates. 

1.  Urine  in  which  urea  exists  in  excess. — Urine  in  which  urea  is  in 
excess  has  a  high  specific  gravity,  and  is  very  prone  to  decomposition ; 
it  has  no  other  peculiar  physical  property. 

Test. — Add  to  a  small  quantity7  of  urine  in  a  watch  glass  about  an 
equal  quantity  of  pure  colorless  nitric  acid ;  if  crystals  appear  urea  is  in 
excess,  and  the  time  within  which  they  form,  which  may  vary  from  a  few 
minutes  to  two  or  three  hours,  and  the  quantity  of  crystals,  will  enable 
us  to  judge  of  the  amount  of  the  excess;  or  put  two  or  three  drops  of 
urine  in  a  plate  of  glass  and  add  two  or  three  drops  of  nitric  acid ;  if 


554  MATERIA    MEDICA   AND    THERAPEUTICS. 

crystals  form  they  can  be  detected  by  the  microscope  :  and  by  a  com- 
parison of  healthy  urine  tested  in  the  same  way,  a  good  idea  of  the 
quantity  of  urea  may  be  formed. 

Symptoms. — A  frequent  desire  to  void  urine,  though  the  quantity 
passed  at  one  time  is  commonly  moderate.  The  quantity  voided  in 
twenty-four  hours  may  not  much  exceed  the  normal  standard,  though  it 
commonly  does  a  little,  but  a  remarkable  feature  of  the  disease  is  the 
facility  with  which  diuresis  is  produced  by  trifling  causes,  as  anxiety,  a 
slight  chill  of  the  surface,  an_l  the  like.  There  is  pain  in  the  back,  indis- 
position to  exercise,  low  spirits,  with  dyspeptic  symptoms  of  greater  or 
less  severity. 

2.  Urine  in  which  lithic  acid  or  the  lithates  predominate. — Urine  con- 
taining excess  of  lithic  acid  is  usually  of  a  high  color,  and  if  the  excess 
is  considerable  the  acid  is  deposited  as  the  urine  cools.  It  always 
appears  as  crystals,  though  they  are  often  so  small  as  only  to  be  recog- 
nised by  the  microscope.*  The  urine  is  acid,  but  not  of  high  specific 
gravity,  unless,  as  not  unfrequently  happens,  there  is  excess  of  urea 
also. 

Lithate  of  Ammonia. — This  is  often  seen  with  lithic  acid,  and  the 
urine  containing  it  is  usually  high-colored  and  turbid,  sometimes  it  is 
clear  when  passed,  and  of  low  specific  gravity.  The  lithate  is  deposited 
as  the  urine  cools  as  an  amorphous  mass.  It  has  commonly  a  fawn 
color,  verging  towards  red.  It  is  the  most  common  of  the  urinary 
deposits.  The  only  one  with  which  it  can  be  confounded  is  earthy 
phosphates,  and  from  them  it  is  distinguished  by  being  redissolved  when 
the  urine  is  heated  and  falling  down  again  when  it  cools.  It  is  dis- 
solved by  adding  liquor  potasse.  Lithate  of  soda  is  usually  found,  and 
sometimes  in  very  large  quantities,  in  urine  containing  lithate  of  ammo- 
nia; this  is  particularly  true  of  the  urine  of  gouty  patients,  in  whose 
systems  lithate  of  soda  often  abounds  to  such  a  degree  that  it  is  depo- 
sited in  the  joints,  forming  the  so-called  chalk  stones.  It  has  also  been 
found  in  the  blood  of  arthritics. 

Lithic  acid  and  the  lithates  are  also  found  in  excess  in  the  urine,  in 
most  cases  of  inflammatory  disease,  in  rheumatism  and  gout.  It  is  very 
common  in  fever.  It  is  often  increased  by  check  of  perspiration  from 
cold,  and  sometimes  accompanies  chronic  skin  disease.  When  too  much 
animal  or  highly  nitrogenized  food  is  taken,  or  the  digestive  organs  are 
impaired  so  that  they  are  unable  to  assimilate  the  usual  quantit}r,  the 
excess  of  nitrogen  will  often  be  eliminated  from  the  kidneys  as  lithic 
acid  and  lithates.  This  is  one  of  the  cases  where  the  presence  of  a 
urinary  deposit  is  evidence  of  the  efforts  of  the  system  to  eliminate  a 

r-  *  The  color  is  yellow  or  red,  varying  through  all  the  shades  of  pale  and  deep 
fawn  color  to  intense  orange  red. 


ALTERATIVES. 

noxious  principle.  On  the  other  band,  in  all  diseases  of  debility,  in 
anemia,  hysteria,  chlorosis,  the  quantity  of  lithic  acid  i  below  the  nor- 
mal standard. 

Therapeutics. —  Where  this  acid  or  the  litbatee  are  in  exce  -,  the 
treatment  must,  be  directed  by  two  indications. 

I.  To  remove  the  diseased  state  upon  which  the  dispo  ition  to  form 
acid  in  excess  depends. 

II.  To  promote  tlie  solution  of  the  acid  and  its  salt-. 
The  means  for  fulfilling  the  first  indication  are  : 

Tims;;  calculated  to  restore  tin1  healthy  functions  of  the  skin,  and  pro- 
mote diaphoresis;   and  those  which  improve  digestion. 

Of  the  former  the  most  available  are  the  warm  or  vapor  bath,  fol- 
lowed by  very  free  and  even  violent  friction  of  the  whole  surface,  ate! 
moderate  exercise  ;  these  measures  will  often  produce  the  besl  effect  . 

To  improve  the  digestion,  alteratives,  and,  if  needful,  mild  tonic  laxa- 
tives, as  rhubarb,  and  soda  or  magnesia,  may  be  followed  by  vegetable 
tonics,  and  in  some  cases  chalybeates.  Of  the  preparations  of  iron  those 
are  to  be  preferred  in  which  the  metal  is  united  to  an  organic  acid,  as 
the  ammonio-tartrate,  the  citrate,  or  lactate. 

Attention  to  diet  is  all-important ;  here,  as  in  most  other  cases,  the 
best  rule  is  to  take  such  articles  only,  and  in  such  quantities,  as  the 
patient  finds  by  experience  he  can  thoroughly  digest. 

Solvents  of  lithic  acid  and  the  lithates. — These  are  the  proper  and 
literal  lithics.  Their  use  is  generally  secondary  to  that  of  the  remedies 
which  have  been  mentioned  as  proper  to  remove  the  diseased  state  of 
the  system  on  which  the  formation  of  the  excess  of  acid  depends.  Still 
they  are  of  importance,  for  they  may  ward  off"  for  a  while  the  dreaded 
evil  calculus,  and  give  time  for  the  proper  operation  of  the  other  and 
more  important  class  of  remedies. 

Of  the  solvents  of  lithic  acid  the  most  important  is  water.  This  is  the 
best  lithic,  not  only  for  this,  but  for  most  other  urinary  deposits.  All 
other  lithics  will  usually  fail,  hardly  acting  at  all,  unless  their  operation 
be  aided  by  free  dilution  ;  and,  on  the  other  hand,  very  many  of  them 
act  promptly  and  with  great  power,  when  presented  to  the  system  with 
plenty  of  water.  Two  or  three  pints  a  day  is  the  proper  quantity  to  be 
taken,  and  if  a  larger  amount  can  be  swallowed  without  impairing  the 
digestive  powers,  the  chance  of  the  acid  being  "  ivashed  away"  is  greatlv 
increased.  A  very  curious  proof  of  the  efficacy  of  water  as  a  lithic  is 
afforded  by  the  Medical  History  of  Malvern  Springs  in  England.  These 
waters  have,  for  a  very  long  time,  enjoyed  great  reputation  in  cases  of 
gout,  gravel,  and  other  chronic  affections;  to  their  efficacy  we  have  the 
testimony  of  Prout,  Bird,  and  other  writers.  Xow  the  water  of  Malvern 
Springs  differs,  except  as  to  temperature,  from  common  spring  water, 
solely  in  its  extreme  purity,  approximating  that  of  distilled  water. 

36 


556  MATERIA   MEDICA   AND   THERAPEUTICS. 

Potash. — This  alkali  may  be  given  in  various  forms,  'as  the  liquor 
potassse,  the  carbonate,  bicarbonate,  tartrate,  citrate,  and  acetate.  The 
liquor  potassse  should  be  given  in  full  doses,  say  3  ss  thrice  a  day  in 
some  mild  fluid,  or  weak,  bitter  infusion.  It  is  apt  even  in  this  form  to 
offend  the  stomach,  and  its  use  cannot  be  persisted  in  a  long  time  with- 
out seriously  impairing  the  digestion.  The  bicarbonate  of  potash  is  a 
very  efficient  and  rather  pleasant  lithic,  it  may  be  given  in  doses  of  3  ss 
thrice  a  day.  It  is  made  more  pleasant  and  grateful  to  the  stomach  by 
giving  it  with  a  few  drops  of  some  weak  acid,  acetic  or  citric,  to  be 
taken  in  the  state  of  effervescence  ;  here  the  citrate  and  carbonate  are 
taken  together,  in  proportions  which  vary  as  more  or  less  acid  is  added. 
If  sufficient  is  added  to  drive  off  all  the  carbonic  acid,  you  then  have,  of 
course,  a  solution  of  the  salt  of  the  vegetable  acid,  and  this  is  the  best 
way  of  taking  citrate  or  tartrate  of  potash. 

Acetate  of  Potash. — This  is  the  best  lithic  salt  of  potash.  It  is  less 
apt  than  the  others  to  disorder  the  digestion,  and  by  the  use  of  the  full 
dose,  3  ss,  three  times  a  day,  the  urine  may  be  kept  alkaline,  and  the 
lithic  acid  diathesis  kept  in  check  for  a  long  time.  Still  it  must  never 
be  forgotten  that  this  alkaline  state  of  the  urine  may  induce  the  form- 
ation of  deposits  of  the  phosphates,  nor  will  the  stomach  always  escape 
an  evil  influence  even  from  this  salt. 

Salts  of  Soda. — Of  these,  those  chiefly  used  are  lithics,  the  carbonate, 
the  borate,  the  phosphates,  and  the  salts  of  vegetable  acids,  in  the  form 
of  effervescing  mixtures.  The  carbonate  is  inferior  to  the  salt  of  potash 
— so  also  are  the  salts  formed  with  vegetable  acids,  though  they  are 
very  much  used  in  the  form  of  soda  powders. 

Borate  of  Soda — [Borax). — The  virtues  of  borax  as  a  lithic  have  long 
been  celebrated  among  the  Germans,  and  much  relied  on  from  the  power 
its  solution  has  of  dissolving  lithic  acid  ;  in  this  it  excels  either  of  the 
alkaline  carbonates.  It  has,  too,  the  advantage  that  it  can  be  used  for 
a  considerable  length  of  time  without  any  bad  effects  on  the  digestion. 
It  is  said  to  have  a  stimulating  influence  on  the  uterus,  and  to  be  on 
that  account  objectionable  in  females.  Dr.  G.  Bird  says  he  has  known 
it  to  produce  abortion  in  two  cases. 

Phosphate  of  Soda. — The  solvent  powers  of  the  solution  of  this  salt 
are  equal  to  those  of  borax,  and  it  has  been  used  as  a  lithic  in  many 
cases ;  its  agreeable  taste  is  a  great  recommendation  ;  it  seems  to  sit 
well  on  the  stomach,  if  given  in  a  state  of  sufficient  dilution. 

Dose. —  3  i  to  5  ss  twice  a  day.  It  may  be  taken  in  broth  or  gruel ; 
its  taste  very  nearly  resembling  that  of  common  salt. 

In  concluding  the  subject  of  the  alkaline  treatment  of  lithic  acid 
diathesis,  it  is  proper  to  repeat  that  alkalies  exert  no  curative  in- 
fluence. The  benefit  to  be  derived  from  their  use  is  palliation,  and 
not  cure.     They  correct  acidity  in  the  products  of  mal-assimilation,  and 


AT.TKIIATIVKS. 

for  this  purpose  should  be  given  in  moderate  dosi  ,\  ■  ■<<  bo  four  b< 
after  eating. 

Urine  in  which  Phosphates  are  in  excess.     [Jrine  containing  pho  - 
phates  in  excess  is  usually  pale  and  of  light  specific  gravity,  L.010, 
secreted  in  largo  quantity,*     Et  is  usually  acid  when   passed,  bul 
becomes  alkaline  "when  the  pho  phi  -     fall  in  large  quantity,  as  tbej  ai  • 
not  in  the  absence  of  acid  soluble  in  tin1,  urine    Unless  the  urine  be© 
alkaline,  this  deposit  (spontaneous)  of  phosphates  will   not  take  p 
even  though  they  exist  in  very  great  quantity.     Tlie  phosphatic  deposil 
is  white,  or  yellowish,  or  greyish  white  ;  it  is  readily  dissolved  by  adding 
hydrochloric  acid,  ami  reappears  when  this  acid  solution  is  supersatu- 
rated with  ammonia,;  they  are  not  affected  by  adding  the  alkalies  or 
their  carbonates,  nor  are  they  dissolved  by  heating  the  urine.     <  »n  the 
contrary,   if  they  exist  in  excess,  the  urine,   though   previously  clear,  is 
made  turbid  by  boiling,  so  that  we  might  suppose  albumen  was  present 
Adding  nitric  acid  pretty   freely  to    the  urine  will,   by  dissolving  the 
phosphates,  render  it  plain  that  albumen  is  not  present. 

States  of  disease  in  which  Phosphates  occur  in  excess. — If  the  excess 
is  but  occasional,  and  varying  in  degree  even  when  present — if  the 
urine  be  deep-colored  and  of  high  specific  gravity,  the  cause  of  the 
deposit  is  dyspepsia.  The  particular  form  of  this  disease  in  which  we 
find  these  deposits,  is  that  connected  with  great  irritability,  both  of  the 
system  at  large  and  the  stomach,  prostration  of  nervous  energy,  and 
general  evidence  of  wear  and  tear  of  body  and  mind.  When  the  urine 
is  pale-,  of  low  specific  gravity,  and  when  the  phosphates  abound  equallv 
at  all  times  of  the  day,  and  when  this  state  of  things  continues  for  a 
considerable  time,  the  phosphatic  deposit  probably  depends  either  on 
organic  disease  of  the  bladder,  prostate,  or  kidney,  or  some  morbid  state 
of  the  spine,  consequent  on  injury  or  idiopathic  disease. 

Therapeutics. — The  deposit  of  phosphates  very  generally  indicates  a 
severe,  and  it  accompanies  a  number  of  utterly  incurable  diseases.  The 
prognosis  is,  therefore,  always  grave  when  the  deposit  is  constant. 
When  it  is  but  occasional,  it  generally  depends,  as  before  stated,  on  an 
irritative  form  of  dyspepsia,  but  even  here  the  probability  is,  that  the 
nervous  system  is  suffering  severely.  Very  little  can  be  done  by  lithics 
proper,  in  either  of  these  forms  of  disease.  Some  practitioners  have 
strongly  commended  acids  with  a  view  of  directly  correcting  the  alka- 
line state  of  the  urine.  It  is  very  doubtful  whether  either  of  the  mine- 
ral acids  have  any  such  power,  though  some  have  attributed  it  to  the 
nitric. 


*  Sometimes  the  urine  containing  excess  of  phosphates  is  high-colored,  and  of  a 
great  specific  gravity  ;  this  usually  occurs  where  the  precipitate  depends  on  dys- 
pepsia, and  is  only  occasionally  present. 


558  MATERIA   MEDIC  A   AST)   THERAPEUTICS. 

Benzoic  acid  has  been  highly  praised,  but  its  operation  is  excessively 
uncertain.  These  cases  must  be  treated  on  general  principles,  and  with 
particular  reference  to  the  disturbed  state  of  innervation.  Narcotics 
will  always  be  required,  and  in  many  cases  you  will  give  them  very 
freely.  Tonics  and  alteratives  judiciously  combined,  a  well-regulated, 
plain,  tbough  nutritious  diet,  and  good  hygienic  management,  will  do 
all  that  art  can  do  for  the  more  severe  cases. 


INDEX. 


Absorption  of  Medicines,  14,  17 

Acetone,  38 

Acetum.  3.'! 8 

Acid,  acetic,  38,  338,  503 

arsenious,  485,  546 

benzoic,  39 

citric,  39,  337 

empyreumatic,  451 

gallic,  39 

hydrocyanic,  40,  314 

lactic,  39 

meconic,  39 

nitric,  489 

oxalic,  40 

prussic,  40,  314 

pyroligneous,  38,  45  L 

sulphuric,  502 

tannic,  40,  495 

tartaric,  41 

valerianic,  41 

vegetable,  337 
Acids,  33 ;  organic,  38 
V  Aconite,  325 
«/"  Aconitine,  327 
vA.ctcea  racemosa,  333 
Affusion,  201,  423 
Alcohol,  48,  417 
Alkalies,  organic,  41 
Allium  sativum,  507 
n[  Aloes,  121 
Alteratives,  517 

chemical,  547 
local,  541 
Althoea  officinalis,  347 
Alum,  501 
Ammonia,  262.428 

carbonate  of,  429,  551 
Ammoniac,  221 
Ammonije,  aqua  acetatis,  204 
Anaesthetics,  394 
Antacids,  548 
Anthelmintics,  150 
Anthemis  nobilis,  90 
Antimonialis  pulvis,  204 
Antimony,  tartrate  of,  82 
vegetable,  206 
wine  of,  86 
Antiphlogistics,  336 


S 


Antispasmodics,  432 
Apium  petrosolinum,  252, 
Apocyaum  caaabmum,  348 

Aqua  acetatis  ainiiioiiiju,  204 
Aqua  ammonias,  429, 505 
Arabic,  gum,  50,  3  I  I 
Arbutus  uva  ursi,  256 
Argentum,  482 
Aricinine,  471 

Aristolochia  serpentaria,  20-8 
Arrow-root,  51,  351 
Arsenic,  162,485 
Arum  triphyllum,  220 
Ascarides,  151 
Asclepias  tuberosa,  207 
Aspidium,  158 
Assafcetida,  440 
Astringents,  491  ^ 
Atropa  belladonna,  387 

Balsams,  47 

Bark,  Peruvian,  462 

Barley,  350 

Baths,  cold,  warm,  hot,  and  vapor.  202, 

203 
Bearberry,  the,  256 
Belladonna,  387 
Benne,  348 
Black  draught.  135 
Black  wash,  1 92 
Bleeding,  271,  310 
Blister,  instantaneous,  21 
Blisters,  507 
Bloodroot,  219 
Blue  pill,  145,  187 
Blue  ointment,  1S8] 
Boneset,  206 
Borax,  556 
Brucine,  43,  44S 
Buchu,  255 
Butterfly  weed,  207 

Cabbage,  skunk.  441 

Cahinca,  258 

Cajeput  oil.  442 

Calamus,  416 

Calomel,  143,  143,  155,  191 

Calumba,  457 


560 


INDEX, 


Camphor,  161r  430 
Cantharides,  249,  509 
Caoutchouc,  47 
Capsicum,  506 
Carbo  ligni,  123 
Carminatives,  33 
Carrot,  255 
Cassava,  353 
Cassia  fistula,  118 

marylandica,  135 
Castor  oil,  20,  112 
Catechu,  496 
Cathartics,  25,  92,  111 
Chalk,  549 
Chamomile,  90 
Charcoal,  123 

Chenopodium  anthelminticum,  159 
Chimaphila,  256 
Chinoidine,  43 
Chlorine,  216 
Chloroform,  49,  402: 
Cicuta,  383 
Cimifuga,  333 
Cinchona,  460 
Cinchonine,  42,  471 
Citrin  ointment,  189" 
Clysters,  148 
Cod  liver  oil,  534 
Codeia,  362 
Codeine,  42 
Cohosh,  333 
Colchicum,  323 

Cold,  use  of,  as  a  sedative,    334 ;    as  a 
refrigerant,  338 ;  as  an  anaesthetic,  403 
Colocynth,  139 
Conium  maeulatum,  283 
Convolvulus  panduratus,  246 
Copaiba,  2,50 
Copper,  sulphate  of,  86 
Cornus  ftorida,  471 
Corrosive  sublimate,  190,  321 
Cotyledon  umbilicus,  490 
Cowhage,  157 
Crane's  bill,  499 
Cream  of  tartar,  139,  238 
Creasote,  449 
Creta,  549 
Cross  wort,  206 
Croton  oil,  142.  147,  513 
Crow's  foot,  499 
Cubebs,  253 
Cucumber,  bitter,  139 

squirting,  140 
Cucurbila  pepo,  162 

Datura  stramonium,  391 
Daucus  carota,  255 
Delphine,  331 

Demulcents,  31,  33,  216,  343 
Dextrine,  51 
Diaphoretics,  193 
Digitalis,  239,  314 


Dinner  pill,  123 
Diuretics,  228 
Dogwood,  471 
Dolichos  pruriens,  157 
Dover's  powder,  206 
Dragon-root,  220 

Effervescing  draught,  205 

Elaterium,  140 

Elixir  proprietatis,  123 

"      salutis,  135 
Emetics,  24,  31,  52r  67 
Emetine,  43,  80 
Emmenagogues,  260 
Emollients,  33 
Enemata,  148 
Epispastics,  507 
Epsom  salts,  128 
Ergot,  264 

Ether,  sulphuric,  48,  226,  40i. 
Eupatorium,  206 
Expectorants,  209 

Fats,  44 

Eecula,  51 

Fern,  158 

Ferrum,  475 

Flag,  sweet-scented,  41  & 

Flax  seed,  349 

Fowler's  solution,  487 

Foxglove,  239 

Gall  nut,  495 

Gallse,  495 

Gamboge,  137,  147 

Garlic,  507 

Gentian,  459 

Geranium  maeulatum,  49S; 

Ginger,  415 

Glauber's  salts,  1.06 

Gold,  531 

"     ehlonde  o£  531 

"    oxide  of,  532 
Goulard's  extract,  500 
Guiac,  261 
Gum,  50 

"     ammoniac,  221 

"     arabic,  50,  344 

"     resins,  47 
Gutta  percha,  48 

Hellebore,  black,  138  ;  white,  329;.  Ame- 
rican, ib. 
Hemlock,  383 
Hemp,  Indian,  248 
Henbane,  380 

Hive  Syrup,  Coxe's,  91,  2.27 
Hop,  382 
Horsemint,  506 
Hydrargyri  bichloras,  190 

"  oxidum,  188 

"  pilulae,  145,  186 


INDEX. 


50] 


Hydrargyri  proto-chlor.,  L48,  170,207 
"         unguentura,  L88 
"         unguentum  nitratis,  189 

Hydrargyrum,  163 

"  cum  creta,  188 

Hydrocyanic  acid,  3 1  I 

1 1  >  osciamus  niger,  *i80 

I  [ypnoticSj  356 

India  rubber,  47 
[ndian  sage,  206 

"       hemp,  248 

"  meal,  351 
Inhalations,  216 
[odine,  522 

"       preparations  of,  523 
Ipecacuanlia,  79,  216,  227,  233 
Iron,  475 

"    ammonio-tartrate,  486 

"     carbonate,  56,  477 

"     citrate,  481 

"     filings,  15fi,  475 

"     lactate,  481 

"     muriated  tincture,  258,  481 

"    oxide,  476 

"     phosphate,  480 

"     sulphate,  156,  479 

"     tartrate,  480 
Issues,  514 

Jalap,  124,  147 
James's  powders,  204 
Jamestown  weed,  391 
Jerusalem  oak,  158 
Jujube,  348 
Juniper,  217 

Juniperus  communis,  247 
"         sabina,  261 

Kino,  497 
Kooso,  162 

Lactucarium,  381 

Laudanum,  376 

Laxatives,  111 

Lead,  acetate  of,  499 

Leeches,  291 

Lemon,  336 

Lignin,  50 

Lime  water,  549 

Linseed,  349 

Liquorice,  346 

Liriodendron  tulipifera,  473 

Lithics,  552 

Lobelia,  88 

Lobeline,  89 

Lupulin,  3S3,  406 

Macrotys  racemosa,  333 
Magnesia,  114,  548 

"         carbonate,  115 

"         sulphate,  128 


Male  fern,  158 

Mallow  '.  man  h,  '■'>  17 

Manna,  117 

Marsh  rosemary,  49 

Materia  mi  dica  denned,  1 1 

Matico,  608 

May  apple,  125 

Meadow  saffron,  323 

Meconine,  22 

Medicines,  effects  of  absorption  of,  14,  17 

"         modus  operandi  <>(;  L6 

"         methods  of  applying,  18 

'•        circumstances  modifying    the 
effects  of,  'i  1 

"         classification  of,  28  \ 

"         combination  of  .'!1 
Melia  azedareck,  1 61 
Mercury,  163,  258,  520 

"       pathological  effects  <>r.  1 10 

"       modes  of  introducing,  172 

"  '     black  oxide,  188 

"        chlorides,  190 

"        iodides,  525 
Mindereri  spiritus,  204 
Monarda  punctata,  507 
Monkshood,  325 
Morphine,  42,  378 

"         sulphate,     acetate,     and    hy- 
drochlorate  of,  378,  379 
Moxa,  514 

Mucuna  pruriens,  157 
Musk,  438 
Mustard.  89 
Myrrh,  224 

Narceine,  42 
Narcotics,  34,  355 
Narcotine.  42,  362 
Nervines,  433 
Neutral  mixture,  205 

salts,  147 
Nightshade,  American,  125 

"  deadly,  387 

Nitre,  235 

"      sweet  spirits  of,  239 
Nitro-muriatic  liniment,  513 
Nux  vomica,  443 

Oak  bark,  49S 

Oatmeal,  350 

Oils,  44;  enumeration  of  the  more   m- 

portant,  45-47 
Opium,  25.  357 
Orange,  337 
Oxydum  hydrargyri  cinereum,  188 

Paint,  Indian,  219 
Papaver  somniferum,  357 
Paregoric,  377 
Pareira  brava,  257 
Parsley,  254 
Parturients,  264 


562 


INDEX. 


Peru,  balsam  of,  222 
Peruvian  bark,  462 
Phosphorus,  431 
Phytolacca  decandria,  125 
Pill,  blue,  145,  187 
Pink  root,  160 
Pipsissewa,  256 
Pix  burgundica,  507 
Pleurisy  root,  207 
Plumbi  acetas,  499 
Plummer's  pill,  191,  521 
Podophyllum,  139,  158 
Poke  weed,  125 
Polygala  senega,  217,  227 
Polypodum  filix  mas,  15S 
Pomegranate,  159 
Potash,  550 
Potassa,  caustic,  545 

"        citras,  205 

"        cum  calce,  546 
Potassse  nitras,  235 

"        carbonas,  550 

"        liquor,  550 

"        et  sod.  tart.,  129 

"        acetas,  239 

"        sulphas,  131] 

"        supertartras,  130 

"       tartras,  129 
Potato,  the  wild,  246 
Powders,  antimonial,  or  James's,  504 
Pride  of  India,  161 
Principles,  vegetable  proximate,  36 
Prunus  virginianus,  474 
Prussic  acid,  40,  314 
Pseudomorphine,  42 
Puccoon,  219 
Pulse,  273 

Pulvis  antimonialis  or  Jacobi,  204 
Pulvis  Doveri,  206 
Pumpkin,  162 
Purgatives,   32 
Pyrola  umbellata,  256 

Quassia,  458 
Quicksilver,  163 
Quinine,  42,  458 

"        sulphate  of,  452 
Quinoidine,  43 

Red  precipitate,  189 
Refrigerants,  31,  336 
Resins,  47 
Revulsives,  504 
Rheumatism  weed,  256 
Rhubarb,  119,  146 
Rice,  351 
Ricini  oleum,  112 
Rochelle  salts,  129 
Rubefacients,  505 

Saffron,  meadow,  323 
Sage,  Indian,  206 . 


Sago,  51,  352 

Sal  de  duobus,  131 

Sal  diureticus,  239 

Salep,  354 

Salicine,  472 

Salix,  472 

Salt,  common,  161 

Saltpetre,  235 

Sanguinaria,  219 

Sarsaparilla,  537 

Sassafras,  539 

Savin,  261 

Scammony,  135,  147 

Scilla  maritima,  86,  219,  227,  246 

Secale  cornutum,  264 

Sedatives,  271 

Seignette,  salt  of,  129 

Senega  snakeroot,  217 

Senna,  132,  146 

Setons,  514 

Sialagogues,  163 

Silver,  nitrate  of,  483,  541 

"      oxide  of,  485 
Simaruba,  459         \ 
Sinapis,  89,  505 
Skunk  cabbage,  441 
Slippery  elm,  348 
Snakeroot,  217 

"         black,  333 
Soda,  551 

"      carbonate  and  bicarbonate,  551 

"      sulphate,  126 

"      phosphate,  132 
Soot,  451 
Soporifics,  355 
Spigelia  marylandica,  160 
Spiritus  mindereri,  204 

"       etheris  nitrici,  239 
Spurred  rye,  264 
Squaw  root,  333 
Squills,   86,  219,  227,  246,  263 
Stannum,  157 
Starch,  51 

Statice  caroliniana,  499 
Stinkweed,  391 
Stramonium,  225,  390 
Strychnine,  43,  445 
Strychnos  nux  vomica,  443 
Styptics,  491 
Sudorifics,  193 
Sugar  of  lead,  499  ' 
Sugars,  enumeration  of  various,  49,  50 
Sulphur,  116 
Swallow- wort,  decumbent,  207 

Tamarinds,  118,  337 

Tannin,  495 

Tapioca,  353 

Tar,  217 

Tartar,  cream  of,  130,  238 

"      emetic,    82,  204,  216,    227,  310, 
512 


IMH.X. 


)6S 


Tasteless  purging  salt,  182 
Temperants,  837 
Thebaine,  42 
Thorn  apple,  391 
Thoroughwort,  200 
'\\,\k „•,..,,  - 'j 5,  :;i7 

"        Indian,  88 
Tolu,  balsam  of,  217,  223 
Tonics,  31,  452 
Tragacanth,  345 
Turmeric,  fed,  219 
Turnip,  Indian,  220 
Turpentine,  oil  of,  158,  248,  265,  506 
Turpeth  mineral,  90 

Urine,  states  of,  552 
Uva  ursi,  256 

Valerian,  439 
Vegetable  antimony,  206 
Venesection,  25 
Veratrine,  43,  329 
Veratrum  album,  329 
"        viride,  329 


Vesicants,  50,7 
Vinegar,  338 
Vitriol,  while,  85 
"      blue,  86 
Vitriolated  tartar,  131 
Volatile  alkali    551 

Wake-robin,  220 

Wash,  yellow  and  black,  l  o  i 

Water,  156,  201,  555 

Willow,  1=72 

Wintergreen,  256. 

Wolfs  bane,  825 

Worms,    account  of  the  various  kinds 

which  infesi   the  human   body,    l-'-'i ; 

symptoms  of,    152:   their  origin,  15:): 

medicines  for  expelling,  155 
\Vm  mseed,  160 

Yellow  wash,  191  ; 

Zinc,  oxide  of,  488 
"     sulphate,  of,  85 


S.  S.  4-   W.   Wood's  Medical  Catalogue 


FOURTH  EDITION  OF 

A    Sorio3  of   Anatomical    Platos, 

With  References  and  Physiological  Comments,  Illustrating  the  structure  of  the  different  paru 

of  the  human  body,  with  200  Hates,  4to,  by  JONES  QUAIN,   Ml),  Prof(     ■■•   at 

and  Physiology  In  the  University  of  London;  and  w.  J.  E.  WILSON,  M.D  ,  l.<  •  Hirer  01 

cal  and  Surgical  Anatomy  and  L'hyslology,     Fourth  edition.    Revised,  ,1,1/,    >  ■,  .,:,  ..  ., 

by  JOSEPH  1'A.NOOAST,  M.D.,  Professor  of  General,  Descriptive,  and  Buqrlcal  Anatomy  lr 

Jefferson  Medical  College  of  Philadelphia,  Lecturer  on  Clinical  Burgcry  at  the  1'tal 

Hospital,  Ac     Price  $l.r>,  free  of  postage. 

"  Much  superior  as  a  system  to  any  that  have  been   hitherto  published  In  this  eOQDtl 

dtecbloo-OhtrwQical  Itemle/w, 

"The  plates  aro  for  the  most  part  exceedingly  well  executed.  It  Is  the  cheapest  wort:  of  lb* 
kind  ever  published  in  this  country." — American  Jourwd  of  Medical  Bdenues. 

"The  text  and  plates  both  being  excellent,  the  book  is  a  treasure  indeed.'1 — Iio»ton  Mtd*  •-»' 
and  Surgical  Journal. 

A  TREATISE  ON  THE 

Etiology,  Pathology,  and  Treatment  of  Congenital  Disioc* 
tions  of  the  Head  of  the  Femur. 

ILLUSTRATED    WITH    PLATES. 

By  JOHN  MURRAY  CARNOOIIAN,  M.D.,  Lecturor  on  Operatic  Surgery  with  Surgical 
and  Pathological  Anatomy,  etc.,  etc. 

"Typographically,  this  is  one  of  the  most  beautiful  works  that  has  emanated  from  the  ined!- 
oal  press  of  this  country  The  plates,  drawn  from  nature,  are  well  finished,  and  are  irery  cred- 
itable to  our  draughtsman.  The  work  itself  treats  of  one  of  tho  forms  of  congenital  deformity, 
the  cause  of  which  Is  unknown,  and  the  cure  doubtful.  The  work  nils  a  gap  which  ban  long 
been  void,  and  the  practitioner  will  gladly  welcome  Its  accession." — Literary  Woi-IaI. 

"This  is  a  praiseworthy  attempt  to  draw  the  attention  of  the  profession  to  a  remarkable 
pathological  condition  of  the  coxo-fetnoral  articulation,  which  has  frequently  been  mistaken 
for  other  diseases  of  this  part,  especially  morbus  coxarius,  ooiarthrocace,  or  the  so-called  bip- 
disoase." — Ohio  Med.  A  Surg.  Journal. 

"  By  far  the  most  complete  and  systematic  work  in  the  English  language,  and  the  only  od« 
which' contains  any  directions  for  treatment ." — Brit.  Am  Med.  &  Physical  Journal. 

"  It  is  remarkable,  in  view  of  the  numeroti>  and  exceedingly  "aluable  treatises  and  contribu- 
tions made  by  English  surgeons  on  the  pathological  condition  of  the  joints,  that  the  subject  of 
congenital  dislocation  of  the  head  of  the  femur,  should  have  been  so'almost  entirely  unnoticed 
by  them. 

"  We  feel  a  pride  that  the  first  monograph  on  this  subject  in  the  English  language  is  from 
the  pen  of  an  American,  and  that  is  creditable  to  its  author." — Am.  Journal  Med.  6cit  ■<■  ex. 

"The  work  before  us,  giving  an  account  of  a  special  department  of  surgery,  cannot  ts.ll  to 
prove  of  interest  to  the  practical  surgeon,  as  it  appears  to  be  an  elaborate  and  faithful  dehnea 
tion  of  a  very  distressing  and  badly-understood  affection,  which,  until  recently,  has  been  deemed 
Incurable,  and  to  which  the  attention  of  the  profession  has  been  directed  only  within  the  last 
few  years."— Medical  Examiner. 

THE    YOUNG  STETHOSCOPIST  j 

OB, 

THE  STUDENT'S  AID  TO  AUSCULTATION, 

By  HENRY  ■'     SOWl/zMJH,  MU*, 

OlTl  69  Till"  WTTOKTIANS  OF  MASSACHUSETTS  GENESAJ.  HOBPEIAZ-, 

•-ice,  $'  -5,  free  of  postage- 
"This  is  an  exceedingly  clover  tittle  work— clear,  concise,  and  to  the  purposp,     V>  i£S*t,w    r 
no  work  on  the  subjeot  better  adapted  to  the  wants  of  the  student  who  Is  just  beginning  &? 
•tudy  of  auscultation." — Medical  Examine''" 

"  We  are  fully  convinced  that  this  work  k  ..„,,  onapted  to  the  wants  of  the  students,  and 
that  it  supplies  an  obvious  deficiency  in  the  medical  literature  of  our  country.  Piain  and 
simple  in  its  arrangement,  accurate  in  details,  and  sufficiently  extensive  for  elementary  pur- 
poses, it  should  become  the  companion   of  every  student  of  auscultation." — Western  Lanct  J 

"This  is  a  concise,  yet  clear  and  comprehensive — compact,  yet  sufficient,  summarv  of  the 
essentials  of  auscultation,  by  an  accomplished  Stethoscopist,  who  derived  at  once  his  zeal  and 
his  knowledge  from  the  fountain  head,  the  teachings  of  the  great  Louis."— Annalist. 

"This  is  a  practical  work  on  auscultation,  and  well  calculated  to  Interest  and  instruct  all  who 
have  a  love  for  the  science  of  physical  diagnosis, v — MifWruri  Med.  a/id  SurgicaJ  Jitw  ".'. 

"Dr.  Bowditeh  has  the  honor  and  credit  of  having  given  to  the  profession  one  of  the  mint 
concise,  clear,  and  comprehensive  works  on  physical  diagnosis,  hitherto  published  In  any 
country." — New  York  Journal  qf  Medici*  e. 

"  It  Is  a  concise,  clear,  and  comprehensive  treatise  on  physical  diignosis,  such  as  every  stri- 
dent requires." — Western  JnurmU  of  Medicine  and  Surgery. 

"  It  is  an  excellent  elementary  treatise,  clear,  precise,  and  accurate,  and  may,  afl  each,  be 
itrongiy  recommended  to  the  student  " — Am.  Journal  0/ Medical  Sciences. 


<b\   S.   4-   W.    Wood/s  Medical  Catalogue. 


THE  ORGANIC  DISEASES  AND  FUNCTIONAL  DISORDERS  0**  THE. 

STOMACH, 

By  GEORGE  BUDD,  M.D.,  F.R.S.,  Professor  of  Medicine  In  King's  College,  London ;  late 
Fellow  of  Caius  College,  Cambridge.    Price  $1  50.  free  of  po&tagt. 

"There  is  no  other  work  extant,  that  gives  so  comprehensive  a  view  of  the  various  affec- 
tions of  the  stomach,  and  certainly  none  emanating  from  higher  authority."—  Western  Lancet. 

"This  work  is  the  fullest  and  most  satisfactory  one,  exclusively  devoted  to  the  Stomach,  that 
we  have  ever  perused.'' — Medical  Counsellor. 

"One  of  the  most  reliable  books  we  have  on  diseases  of  the  ctomach,  and  should  be  in  the 
library  of  every  practitioner  of  medicine." — Cincinnati  Medical  Observer. 

"To  all  those  who  have  studied  '  Budd  ob  the  Liver,'  this  companion  work  which  we  have 
now  before  us  will  be  doubly  welcome. 

"  "We  are  satisfied  that  the  student  can  find  nowhere  a  hotter  treatise  on  the  organic  and 
functional  disorders  of  the  stomach." —  Virginia  Medical  Journal. 

"Plain  and  practical,  evidently  founded  to  a  great  extent  on  his  own  experience,  it  presents 
us  with  a  valuable  summary  of  what  we  all  need  on  this  subject,  and  which  may  be  consulted 
with  much  advantage  to  the  practitioner." 

"As  a  practical  treatise  it  can  hardly  have  a  rival." — Boston  Med.  and  Surgical  Journal. 

"It  is  an  eminently  practical  work,  pointing  out  very  clearly  the  Indications  for  remedial 
measures,  so  far  as  our  present  clinical  knowledge  enables  us  to  go." — I>ubHn  Quarterly  Jour- 
nal of  Madia il  Science. 

"The  profession,  already  indebted  to  Prof.  Budd,  for  one  of  the  best  monographs  on  Diseases 
of  the  Liver,  will  not  fail  to  appreciate  the  present  excellent  work  on  gastric  affections."— 
Southern  Medical  and  Surgical  Journal. 

"  We  regard  it  as  one  of  the  best  and  most  reliable  works  on  the  subject,  that  has  appeared 
for  a  long  time." — Eclectic  Medical  Journal. 

"The  whole  subject  is  brought  up  quite  to  the  times,  treated  in  a  full,  clear,  scientific,  and 
highly  practical  way. 

"  We  must  say  we  should  suspect  any  physician  of  neglect  or  indifference  to  the  best  interest 
of  the  sick,  who  neglects  to  consult  Budd  on  Diseases  of  the  Stomach." — Iowa  Med.  Jour. 

"The  work  will  be  found  an  excellent  monograph,  which  the  dietetic  habits  of  many  Ameri- 
cans renders  of  peculiar  interest  to  the  profession  in  this  country." — College  Jour.  Med.  Science. 

The  Practitioner's  Pharmacoposia,  and  Universal  Formulary; 

Containing  Two  Thousand  Classified  Prescriptions,  selected  from  the  practice  of  the  most 
eminent  British  and  Foreign  Medical  authorities,  &c,  &c. 

By  JOHN  FOOTE,  M.R.C.S.,  London,  with  additions  by  Benjamin  "W.  McCreadt,  M.D., 
Professor  of  Materia  Medica  and  Pharmacy  in  the  College  of  Pharmacy,  N.  Y.,  &c. 

Price  $1  25,  free  of  postage. 

"  Dr.  Foote's  Formulary  Is  an  excellent  one  of  its  class,  and  we  take  pleasure  in  commending 
it  to  the  profession." — Medical  Examiner. 

"  We  recommend  it  as  the  best  work  of  the  kind  with  which  we  are  acquainted." — New 
York  Medical  Times. 

"  This  is  another  of  those  works  designed  to  assist  the  practitioner  in  time  of  need  and 
argency ;  it  will  be  found  to  meet  very  fully  these  Indications." — Nelson's  Am.  Lancet. 

"  Its  appropriate  place  is  on  the  table  or  desk  ready  for  daily  or  hourly  consultation.  No  one 
who  possesses  it,  and  appreciates  its  merits,  will  give  it  a  place  elsewhere,  except  to  rest,  whilst 
he  is  doing  the  same." — Medical  Counsellor. 

"The  newest  in  regard  to  the  materials  which  compose  it,  the  easiest  of  reference,  and  the 
most  valuable  compendium  for  daily  use." — New  Hampshire  Journal  of  Medicine. 

SECOND    EDITION    OF    THE 

DISEASES      OF      THE      RECTUM, 

By  RICHARD 'QUAIN,  F.R.S.,  Professor  of  Clinical  Surgery  In  University  College,  SurgeoH 

to  University  College  Hospital,  &o.    With  colored  plates.    8vo. 

Price  |2  25,  free  of  postage. 

"An  extremely  good  guide  for  all  who  have  to  deal  with  these  troublesome  complaints."— 
British  and  Foreign  Medico-Ohirurgical  Review. 

"Few  works  on  the  subject  contain  bo  much  useful  and  really  practical  Information." — Asso* 
elation  Medical  Journal. 

"It  Is  the  best  treatise  on  the  diseases  of  the  rectum." — New  York  Journal  of  Medicine. 

"  It  is  one  of  the  best  we  have  met  with  on  the  subject." — Ihiblin  Q'ly.  Jour.  Med.  Science. 

"Wo  are  acquainted  with  few  works  so  practical,  concise,  clearly  written,  and  distinguished 
by  such  sound  sense  as  ta».s." — Medical  Times  and  Gazette. 


THE  DISEASES  OF  WOMEN  AND  CHILDREN. 

BY  GUNNING  S.  BEDFORD,  A.M.,  M.D., 
Professor  of  Obstetrics,  the  Diseases  of  Women  and  Children,  and  Clinical   . 
wifery,  in  the  University  of  New  STork,  Author  ofthi   Pi 
and  Practice  of  Obstetrics. 

SIXTH  EDITION,  CAIIEFULLY  REVISED  AND  ENLARGED,  8vo,  653  pp. 
S.  S.  *  W.  WOOD,  389  BROADWAY,  NEW  YORK. 

Price,  $3.25,  free  of  Postage 

Tub  rapid  and  wido-sproad  circulation  of  this  eminently  practical  work  is,  wo 

think,  without  precedent — having  reachod  its  Sixth  Edition  in  little  over  j 

from  the  day  of  its  first  publication.     It  is  a  storehouse  of  knowledge  for  the 
and  practitioner  of  medicine — full  of  practical  precepts  and  bod-side  information. 
Rarely  has  any  medical  publication  met  with  such  universal  commendation  from 
the  medical  press,  botli  at  homo  and  abroad. 

"  Successful  as  the  work  has  boon  at  home  and  abroad,  we  were  not  prepared 
to  see  it  achieve  a  success  exceedingly  rare  in  the  history  of  American  medical 
authorship,  viz.,  a  Translation  into  the  French  language.  We  congratulate  the 
author  upon  this  high  compliment  paid  to  his  labors  in  the  still  new  field  of 
pathology,  where  so  many  struggle  vainly  for  reputation.  While  this  tran 
is  the  highest  possible  acknowledgment  of  the  value  of  Dr.  Bedford's  labors,  it 
secondarily  reflects  creditably  upon  the  rising  importance  of  the  American  school 
of  medicine. — American  Medical  Times. 

"We  hail  the  advent  of  such  a  work,  abounding  in  practical  matter  of  the 
deepest  interest,  and  illustrated  by  principles  and  laws  ordained  by  nature.  Xor 
can  we  refrain  from  expressing  our  surprise  and  gratification  at  finding  the  book  so 
remarkably  exempt  from  the  superficial  views  that  abound  in  the  great  thorough- 
fare of  medicine.  The  rapid  sale  of  this  work  we  believe  to  be  unprecedented  irj 
the  history  of  medical  literature  in  this  country,  which  must  be  highly  gratifying  tc 
the  author,  showing,  as  it  does,  the  degree  of  estimation  placed  upon  his  labors  by 
the  medical  public." — If.  Y.  Jour,  of  Med.  and  the  Collateral  Sciences. 

"  We  are  quite  sure  that  the  work  will  be  a  welcome  addition  to  professional  li- 
braries in  Great  Britain  as  well  as  America." — Brit,  and  For.  Med.-Ohir.  Review. 

"  We  think  this  thw  most  valuable  work  on  the  subject  ever  presented  to  the 
profession.  We  have  perused  every  page  of  the  book  with  interest,  and  speak, 
therefore,  from  personal  knowledge." — Cincinnati  Med.  Jour. 

"  A  careful  perusal  of  Dr.  Bedford's  book  has  led  us  to  believe  that  its  value  wiL 
continue  to  be  acknowledged,  and  the  author  recognized  as  a  most  able  and  acute 
practitioner  of  medicine.  The  work  is  of  the  most  practical  character;  every  thing 
is  made  to  tend  toward  the  relief  and  treatment  of  disease,  and  remarkable  skill  is 
shown  in  quickly  arriving  at  an  accurate  diagnosis.  To  get  at  once  to  the  point  is 
the  pervading  characteristic  of  the  author's  teachings.  We  cordially  recommend  it 
to  all  practitioners  and  students  of  medicine." — London  Lancet. 

"  It  is  to  be  regretted  that  we  have  not  more  such  books  in  Great  Britain." — 
London  Medical  Times  and  Gazette. 

"  The  style  of  the  author  is  very  graphic.  The  book  not  only  proves  Dr.  Bedford 
to  be  a  sound  physician  and  an  excellent  clinical  teacher,  but  it  also  affords  evidence 
of  an  extensive  acquaintance  on  his  part  with  the  literature  of  his  subject  on  this 
side  of  the  Atlantic." — London  British  Medical  Journal. 

"An  examination  of  this  work  convinces  us  that  the  author  possesses  great 
talent  for  observation,  and  that  his  opinions  are  sound  and  practical.  He  shows  an 
intimate  knowledge  of  the  doctrines  of  the  ancients  and  the  opinions  of  the  moderns. 
The  variety  of  instruction  contained  in  this  volume,  the  ability  with  which  it  is  pre- 
sented, and  the  truthful  practical  character  of  the  doctrines  advanced,  give  to  it  very 
great  value." — Gazette  Medicate,  Paris. 


S.  S.  $>   IV.   Wood's  Medical  Catalogue 


"  The  working  men  in  America  ure  always  on  the  look-out  tor  the  new  lights 
rising  over  the  old  world,  and  they  often  too  hastily  adopt  as  the  pnre  gold  of  science, 
the  crude  lucubrations  which  must  find  place  with  more  valuable  matter  in  the 
weekly  medical  press.  But  this  observation  does  not  apply  to  our  author,  who  is 
jredita-bly  known  by  other  works,  and  hi  the  one  before  us  shows  himself  to  be  a 
judicious  physician,  anxious  alike  for  the  good  of  his  patients  and  of  his  pupils ;  one 
who  has  acquired  the  happy  art  of  teaching  how  to  get  at  the  characteristics  of 
disease,  and  how  to  drag  at  the  chain  of  effects,  until  the  mind  grasps  the  first  link 
in  the  chain." — Rankin's  Half-Yearly  Abstract  of  the  Med.  Sciences. 

"  The  subjects  have  been  developed  with  no  ordinary  powers  of  clinical  instrua 
tion." — N.  7.  Med.  Times. 

'  W  e  have  been  both  pleased  and  instructed  by  a  perusal  of  the  book,  and  con 
fidently  recommend  it,  therefore,  to  the  profession,  as  an  excellent  repertorium  of 
clinical  medicine.  The  eminently  practical  ideas  of  the  author,  clothed  in  simpla 
and  perspicuous  language,  ars  delivered  in  quite  an  attractive,  affable,  and  off-hand 
manner." — Philadelphia  Med.  Examiner. 

"  It  is  not  often  that  British  critics  commend  an  American  book ;  so  when  their 
approval  is  obtained,  we  may  rest  assured  that  the  work  commended  is  of  no  ordi- 
nary merit.  Dr.  Bedford's  book  is  characterized  by  Dr.  Churchill  as  '  worthy  of  its 
author,  a  credit  to  his  country,  and  a  valuable  mine  of  instruction  to  the  profession  at 
large.1  We  have  read  every  page  of  the  work,  and  feel  called  upon  to  say  that  we 
regard  it  the  most  valuable  contribution  on  the  subject  ever  offered  to  the  profes- 
sion."—  Charleston  Med.  Journal  and  Review. 

"  A  work  of  great  practical  interest— one  well  calculated  to  interest  and  instruct 
the  busy  practitioner ;  it  points  out  to  him  the  most  modern  therapeutical  agents, 
and  their  method  of  administration ;  and,  above  all,  gives  beautiful  and  satisfactory 
explanations,  physiologically,  of  the  symptoms  of  disease.  This  latter  quality  is  a 
great  merit  of  the  book.  As  a  faithful  representation  of  the  daily  labors  and  duties 
of  a  physician  of  our  day,  and  as  an  accurate  delineation  of  the  diseases  of  women 
and  children,  it  is  well  deserving  of  our  praise." — Virginia  Med.  and  Surg.  Jour. 

"  We  were  actually  fascinated  into  reading  this  entire  volume,  and  have  done 
so  most  attentively ;  nor  have  we  ever  read  a  book  with  more  pleasure  and 
i  rofit.  There  is  not  a  disease  connected  with  infancy  or  the  female  system 
which  is  not  most  ably  discussed  in  this  excellent  work." — Dublin  Quarterly 
Journal  of  Medical  Science. 

"  Professor  Bedford's  book  is  a  good  one.  ,  We  like  it,  for  we  can  digest  a  dinner 
over  it  without  going  to  sleep,  and  that  is  more  than  we  can  say  of  most  medical 
books." — New  Jersey  Med.  Reporter. 

"  To  read  this  work  is  to  be  struck  with  its  truthfulness  and  utility  ;  we  find  all 
tnat  is  useful  in  practice,  ably  communicated,  and  elegantly  expressed.  American 
works  are  not  generally  read  on  this  side  the  Atlantic,  but  we  recommend  Dr. 
Bedford's  book  as  worthy  of  the  very  best  attention  of  the  profession." — Midland 
Quarterly  Journal  of  the  Medical  Sciences,  London. 

"  TVe  have  said,  on  former  occasions,  that  the  man  who  will  bring  forward  clinical 
or  practical  instruction  to  bear  upon  the  medical  teachings  of  our  country,  will  be 
immortalized.  We  want  practical  observations — fresh  from  the  bed-side.  Dr.  Bed- 
ford's volume  is  drawn  from  an  extensive  clinic,  founded  by  him  in  the  University 
of  New  York,  and  is  fortified  by  much  reading  and  research.  This  is  a  good  book, 
and  the  profession  owes  Dr.  Bedford  hearty  thanks  for  the  labor  he  has  bestowed 
upon  it." — Philadelphia  Med.  and  Surgical  Journal. 

"  The  work  before  us  is  eminently  practical,  and  therefore  valuable  as  a  contri" 
bution  to  medical  knowledge.  Prof.  Bedford's  extensive  opportunities  have  enabled 
him  thus  to  bring  together  a  large  number  of  the  most  interesting  cases  of  female 
and  infantile  affections,  and  to  indicate  his  views  of  their  treatment.  Li  the  accom- 
plishment of  the  task,  the  author  has  evinced  a  degree  of  discernment  which  wTilL 
doubtless,  add  materially  to  his  already  extended  ^reputation." — Southern  Med.  and 
Surg.  Journal,  Augusta,  Georgia. 

"  No  one  can  read  this  book  without  becoming  convinced  that  it  contains  much 
valuable  instruction,  and  is  the  result  of  a  large  experience  in  this  specialty." — 
New  Hampshire  Jour,  of  Med. 

"The  work  contains  graphic  descriptions  of  the  diseases  of  women  and  children, 
with  judicious  advice  as  to  treatment." — Boston  Med.  and  Surg.  Jour. 
Price  $3.25,  toy  mail,  free  of  postage. 


»S'.  cf-  W.   Wood's  Medical  Catalogue. 


Lectures  on  Natural  and  Difficult  Parturition. 

BY  EDWAED  WILLIAM  MUKI'IIY,  A.M.,  BUD, 
Professor  of  Midwifery,  University  College,  London  ;  Obstetric  Ph/UStciCM,  OMntrsttp  CoU 

lege  Hospital  ;  and  formerly  Assistant- J'hj/Mirian  to  Dublin  Lf/ingAn  HoH/nUU 
One  vol.  8vo.     Price  $1  7ft,  free  of  postage.     Illustrated  by  Seventy  Engravlnga, 

"This  Is  a  very  excellent  trcatlce  on  Obstetrics." — American  Journal  of  Mid.  80U/IWM. 

"  It  lias  high  claims  upon  the  attention  of  the  profession ;  even  old  practitioner!  may  con  mi  If 
lis  pages  wlili  profit 

"  W"  know  of  no  work  which  we  can  so  heartily  commend  to  the  Student,  and  to  the  eo 
eoucheur  In  active  practice  afl  that  which  constitutes  the  Subject  of  tola  notice.'— fjmithern 
Journal  of  Medicine  and  Pharmacy. 

"The  author  writes  like  ono  thoroughly  acquainted  with   the  literature  and   practice  Of  tbll 
branch  of  the  profession;  and  the  work  must  certainly  be  regarded  as  a  most  excellent  one  >.1 
its  kind.     The  view  of  the  author  seems  to  be  to  condense  within  a  moderate  corni  MS  1 I 
mass  of  materials  furnished  by  other  and  more  voluminous  works." — New  Orleant   Medical 
anil  Surgical  Journal. 

"The  subjects  are  well  chosen,  and  suitably  arranccd  ;  covering  all  the  grojnd  usually  em- 
braced In  a  course  of  lectures  on  obstetrics,  all  of  which  are  presented  In  n  cl  wr  and  forcible 
manner.  The  style  is  luminous  and  readable  Throughout,  the  work  Is  Illustrated  by  wood- 
cuts  exhibiting  the  different  stages  of  labor,  the  organs  involved,  and  the  Instruments  employed 
In  delivery." — St.  Louis  Medical  aud  Surgical  Journal. 

"The  studont  will  find  it  replete  with  accurate  and  lucid  instruction." — London  Med.  0'ar.et1& 

"This  is  an  excellent  book.  It  is  commended  to  us  by  the  position  and  rich  practical  expe- 
rience of  the  author.  It  is  comprised  within  limits  which  will  not  exhar.Pt  while  it  improves, 
and  Is  not  so  expensive  as  to  make  it  a  very  serious  question  whether  it  shall  be  bought  or  net. 
It  consists  of  thirteen  lectures,  on  Important  matters;  embracing,  In  short,  what  It  behooves 
every  practitioner  to  know,  and  to  know  thoroughly." — Boston  Medical  <fc  Surgical  Journal. 

"The  mechanism  of  parturition,  the  keystone  of  correct  operative  midwifery.  Is  detailed  with 
singular  clearness  and  perfection.  The  chapters  on  Natural  Labor  leave  nothing  to  bedesired. 
while  those  on  Difficult  Parturition — and  how  embarrassing,  how  wearying  cases  of  this  kind 
are,  every  one  engaged  in  obstetrical  practicef,but  too  well  knows — seem  to  us  to  supply  fully 
the  wants  of  the  student,  as  to  their  causes  and  the  remedy.  "We  earnestly  recommend  it  to 
the  learner  as  the  monograph,  par  excellence,  on  the  subject." — The  Annalist 

"As  an  elementary  treatise  on  the  Obstetric  art,  and  as  a  text-book  for  students,  we  are  oi 
opinion  that  Dr.  Murphy's  Lectures  should  rank  very  high.  The  style  Is  plain,  simple,  con- 
olse,  and  agreeable;  and  the  principles  of  practice  taught  are  based  upon  an  enlarged  view  oi 
the  philosophy  of  the  art,  as  well  as  ample  practical  experience." —  Western  Lancet. 

These  Lectures  "contain  a  large  amount  of  sound  practical  matter.  From  a  careful  perusal 
of  them,  we  feel  satisfied  that  not  the  student  merely,  but  also  the  practitioner,  may  derive 
much  valuable  Information,  conveyed  In  a  pleasing  and  unassuming  style." — Dublin  Quar- 
terly Medical  Journal  of  Science 

A  MANUAL  OF   DISEASES  OF  THE  SKIN, 

From  the  French  of  M.  M.  Cazenave  &  Sohedel,  with  notes  and  additions,  by  THOMAS  H. 

BUBGESS,  Skin  Dispensary  Physician,  &c.    Second  American  Edition,  fro"' 

the  last  French  edition,  with  notes,  by  H.  D.  BULKLEY,  M.D., 

Physician  to  the  New  York  Hospital,  Fellow  of  the 

College  of  Physicians  of  New  York, 

Lecturer  on  Skin  Diseases,  etc 

Price,  $1  75  cents,  free  of  postage. 

"  This  is  a  book  of  great  value.    It  is  the  hand-book  used  at  the  hospital  of  St  Louis  Id 

Paris,  where  large  nun  'jers  of  patients  affected  with  every  form  of  skin  diseases  are  collected. 

Dr.  Bulkley  has  edited  it  faithfully,  and  his  additions  in  the  way  of  notes  are  valuable  Instead 

oi  cumbrous.    These  diseases  are  not  frequent  enough  in  ordinary  practice  here  to  keep  us  in 

the  habitude  of  diagnosing  or  treating  them  promptly,  and  our  neglect  of  them,  after  leaving 

the  hospitals,  renders  some  work  specially  devoted  to  the  subject,  necessary.     No  work  that 

we  know  of  will  supply  our  necessity  better  than  that  of  Cazenave  and  Schedel     It  is  cheap, 

handy  and  reliable." — Stethoscope. 

"  This,  the  second  edition  of  a  work  long  and  favorably  known  to  the  Profession,  is  one  of  the 
most  concise,  complete,  and  practical  treatises  with  which  we  are  acquainted ;  it  has  been  mucb 
increased  both  in  matter  and  practical  import  by  the  American  Editor,  Dr.  Bulkley,  who  has 
acquired  an  enviable  reputation  by  his  long  attention  to  Cutaneous  affections,  and  a  so  by  Ihe 
ample  field  of  experience  he  has  long  labored  in,  and  not  without  reaping  a  rich  harvest" — 
Northern  Lancet. 

"There  is  no  text  book  on  diseases  of  the  skin,  now  in  the  hands  of  the  profession,  wnich  Is 
so  universally  accepted  as  reliable  authority,  as  that  of  Cazenave  and  SchedeL" — Ohio  Med. 
and  Surg.  Journal. 

"  This  is  the  second  American  edition  of  a  valuable  work  npon  diseases  of  the  skin,  and  con- 
tains not  only  the  notes  of  the  American  editor,  Dr.  H.  D.  Bulklev,  but  also  those  of  Dr.  Thoa. 
H.  Burgess,  editor  of  the  English  edition.  It  is  direct,  full,  and  explicit  in  its  descriptions, 
and  conveniently  arranged  for  reference." — New  Hampshire  Journal  of  Medicine. 

"This  is  eminently  a  practical  work,  and  we  know  of  no  tr  aidse  on  skin  diseases  better 
suited  to  the  wants  of  the  general  practitioner.  Tie  classification  is  on  the  basis  of  tha"  of  Wil- 
lan,  which  will  always  be  retained,  as  it  possesses  advantages  superior  to  those  of  the  new  ar- 
rangement proposed  by  "Wilson.  Dr.  Bulkley  has  aadeu  some  valuable  uoces  to  the  pieseiit 
edition."— Buffalo  Med,  Jour^ZL 


&\   S.  &r    W.    Wood's  Medical  Catalogue. 


FOURTH  EDITION  OF 


Translated  s>y  P.  8.  TOWNSEND,  M.D.,  under  the  supervision  of;  and  with  Notes  and  Addi- 
tions by, 
VALENTINE  MOTT,  Ma»., 

Professor  of  Surgery  in  the  University  of  New  York,  (fee,  dkc,  with  Additions  by  GEORGE 
C.  BLACKMAN,  M.D.,  Professor  of  Surgery  in  Medical  College  of  Ohio,  Ac.  In  8  vols.  8vo. 
anil  a  Quarto  Atlas  of  Plates.  Price  $15,  free  of  postage.  Of  this  valuable  work,  the  revisions 
anil  additions,  &c,  Dr.  Mott  has  furnished  the  following  recommendation,  viz. : 

"  Depau  Row,  July  11,  1856. 

"  6.  8.  &  W.  Wood:  My  Friends:  I  have  looked  through  the  three  ponderous  volumes 
your  last  edition  of  Velpeau  generally :  some  of  the  chapters  I  have  examined  with  great  care. 

"  My  astonishment  is  renewed  in  beholding  the  prodigious  labors  and  learning  of  Velpeau. 

"  The  new  arrangement  ol  some  of  the  chapters,  particularly  the  extended  one  on  aneu- 
risms, have  greatly  improved  the  work. 

"  The  additions  In  brackets  throughout  the  whole  text,  as  made  by  Dr.  Blackman,  with  the 
American  Appendix,  of  more  than  one  hundred  pages,  brings  it  up  to  the  present  time  in  Euro- 
pean and  American  Surgery. 

"It  is  now,  indeed,  a  National  Surgery,  and  ought  to  be  laboriously  and  faithfully  studied 
by  our  pupils,  and  made  a  constant  work  of  reference  by  every  Surgeon. 

"Truly,  your  friend,  V.  MOTT." 

"  The  present  edition  of  this  work  is  an  improvement  upon  its  predecessors.  The  hand  ol 
revision  is  seen  principally  in  the  second  volume,  while  to  the  third,  we  have  added  an  Ameri- 
can appendix  of  134  pages.  Of  the  additions  which  Dr.  Blackman  has  made  to  the  text,  we 
shall  not  speak  farther  than  to  say  that  they  are  judicious,  and  are  designed  to  bring  >.be  litera- 
ture of  each  subject  down  to  the  present  time.  The  editor  exhibits  that  extensive  and  critical 
knowledge  of  the  progress  of  surgery  which  has  always  characterized  his  writings,  and  which 
peculiarly  fitted  him  to  the  task  of  revising  a  work  of  such  literary  researches  as  the  Elements 
of  Velpeau. 

"  The  American  Apr  endix  added  to  the  third  volume  embraces  a  large  number  of  subjects 
which  could  not  be  inserted  in  the  body  ol  the  work.  This  portion  adds  much  to  the  value  of 
the  fourth  edition,  by  rendering  it  complete  in  its  historical  details  of  operations  to  the  present 
•line." —  Nemo  York  Journal  of  Medicine. 

"  '  Mott's  Velpeau '  is  too  widely  known  to  the  profession  In  this  country  to  require  a  special 
ootice  at  our  hands.  It  is  universally  admitted  to  be  the  most  extensive  work  on  operative 
mrgerv  that  has  ever  appeared  in  the  English  language. 

"  In  his  preface,  Dr.  Blackman  remarks  that  it  has  been  his  object  to  arrange  the  work  more 
methodically,  and  to  incorporate  the  more  important  contributions  made  in  the  department  oi 
Operative  Surgery,  during  the  past  ten  years.  His  valuable  statistics  of  operations  on  the  arte- 
ries, of  amputations,  of  exsections  of  the  bones,  &c,  are  to  be  found  under  their  appropriate 
beads  in  the  text  of  the  work.  His  Appendix,  arranged  in  alphabetical  order,  and  comprising 
I  SI  pages,  with  numerous  wood-cuts,  is  at  the  end  of  the  volume,  and  contains  much  valuable 
Information  for  the  practical  surgeon." —  Western  Lancet. 

"The  previous  editions  have  been  long  known  and  appreciated  by  the  profession;  and  the 
present  one  will  be  equally  w»ll  received  as  a  decided  improvement  upon  its  predecessors,  in 
iccordance  with  the  progress  of  the  operative  science  and  art  to  which  its  twenty-eisht  hun- 
dred and  seventy-three  elosely  printed  pages  are  devoted.  *  *  *  Dr.  B'ackman  has  per- 
formed his  laborious  and  responsible  task  with  adequate  fidelity  and  ability ;  and  has  well 
earned  the  respect  as  well  as  thanks,  of  all  who  desire  to  possess  one  ot  the  most  voluminous 
\m\  comprehensive,  if  not  the  most  authoritative,  treatise  on  the  elements  of  Operative  Snr- 
;ery  yet  published  In  the  United  States." — American  Journal  of  Medical  Sciences. 

"  It  is  a  work  which  embraces  almost  every  known  or  imagined  operation  of  early  or  lata 
times,  and  is  indispensable  as  a  work  of  reference  to  surgeons." — 1U.  Ala.  Med.  A  Surg.  Jour. 

The  Anatomical  Remembrancer; 

OB.  COMPLETE  TOCKET  ANATOMIST: 
Containing  a  concise  description  of  the  structure  of  the  human  body. 
Second  Edition. 
With  corrections  and  additions  by 
C.  E.  ISAACS,  M.D., 
Demonstrator  of  Anatomy  in  the  University  of  New  Vork. 
Price  50  cts.,  free  of  postage. 
"It  Is  anatomy — clear,  correct,  and  practical — in  a  nut-shell." — Nelson's  American  Lancet 
"A  very  completo  and  convenient  little  book,  for  the  use  of  students  in  the  dissecting-room." 
^Southern  Med.  and  Surg.  Jour. 

"It  presents,  In  admirable  miniature,  an  outline  picture  of  the  whole  subject,  so  concen- 
trated that  a  short  time  only  is  necessary  to  review  the  whole  science.  It  Is,  in  fact,  anatomy. 
In  a  nut-shell." — Eclectic  Med.  Jour. 

"A  valuable  little  companion  for  the  student  of  anatomy,  or  for  any  persona  who  may  ba 
preparing  tharasolves  for  an  examination."' —  Western  Lancet. 


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